Clinical Features And Correlation Analysis Of Prognosis Of Primary Breast Lymphoma

Background: The data of the latest China cancer registry annual report shows that6 persons per minute were diagnosed with malignant tumors in China,and 1 person per4-5 persons died of cancer.In recent years,the incidence of malignant tumors has increased,and the mortality rate in China's urban residents has exceeded that in cardiovascular and cerebrovascular diseases.Malignant lymphoma(ML)is a class of malignant tumors of the lymphoid hematopoietic system,which is characterized by the proliferation of lymph nodes or secondary lymphoid tissue.ML may involve almost all the organs of human body.ML is divided into Hodgkin lymphoma(HL)and non-Hodgkin lymphoma(NHL).About 90% of patients are NHL,whose prognosis is relatively poor.During the past two decades,the incidence of NHL has been rising,especially the extranodal lymphoma[1].Primary breast lymphoma(PBL)is a rare type of extranodal lymphoma.PBL accounts for 1% of NHL,0.04-0.5% of breast malignant tumors,and 2.2% of the extranodal lymphoma[2-3].The most common type is diffuse large B cell lymphoma(DLBCL).More than 70% of the PBL derives from the B cell line,and only few derives from the T cell line[4].Objective: To analyze the clinical features of primary breast lymphoma patients and to find out the adverse prognostic factors,providing a reference for clinical work.Methods:1.The clinical data was collected from 11 patients withpathological-proved PBL treated from January 2005 to October 2015 in the Second Affiliated Hospital of Dalian Medical University,including the patients' gender,age,initial clinical manifestation,primary site,tumor size,axillary lymphonodus involvement,pathological types,clinical stage,B symptoms,serum lactate dehydrogenase(LDH)level,serum ?2-microglobulin(?2-MG)level,International Prognostic Index(IPI)score,treatment,and central nervous system(CNS)prevention.2.The data was statistically analyzed by the SPSS 17.0.Kaplan-Meier method was used for analysis of the survival data and prognosis.Log-rank method was for single factor analysis,and COX proportional hazard model for multivariate analysis to analyze the influence of clinical factors on the prognosis of the disease,with P<0.05 as the statistically significance.Results:11 patients accounted for 1.8% of all NHL patients(i.e.,n=623)treated in the Second Affiliated Hospital of Dalian Medical University during the same period.Gender: all these 11 patients were female.Age at diagnosis: 26-60 years old,and the median age was 42 years.The initial clinical manifestation in all of the patients was painless breast tumor.Primary sites included left breast(n=5),right breast(n=4),bilateral breasts(n=2),central or inner quadrant(n=5),and outer quadrant(n=6;comprising 4 cases of upper outer quadrant).Median size of primary tumor was 4cm(1-7cm).Axillary lymphonodus involvement included the ipsilateral axillary lymphonodus(n=4),while the other 7 patients weren't involved.Pathological types included DLBCL(n=8),follicular lymphoma(FL;n=1),mucosa associated lymphoid tissue(MALT)lymphoma(n=1),and an undifferentiated lymphoma between DLBCL and Burkitt's disease(n=1).The eight DLBCL patients comprised 2 germinal center B cells(GCB)lymphoma and 2 non germinal center B cells(NGCB)lymphoma,while the status in the left 4 patients were not detected.Clinical stage included IE(n=5)and IIE to IV(n=6).B symptoms were present in 1 patient.Serum LDH level was increased in 5patients and normal in 6,while Serum?2-MG was increased in 7 and normal in 4patients.IPI scored 0 ~ 1(n=8)or at least 2(n=3).Treatments included chemotherapy alone(n=1),surgery plus chemotherapy(n=9),and surgery plus chemotherapy andradiotherapy(n=1).3 patients received R-CHOP,while 4 patients received CHOP and 3patients received CHOPE.1 patient underwent CNS prevention.8 CRs,1 SD and 2 PDs were observed post to the first-line therapy.2 patients had no relapse,in contrast to 9with relapsed after treatment,including 2 with CNS recurrence and 1 with breast recurrence.Single factor analysis showed that the bilateral breast involvement(P =0.043),increased serum ?2-MG levels(P = 0.035),IPI scoring at least 2(P = 0.043)are related to poor prognosis,while factors with uncertainty in their correlation to prognosis included tumor size,primary quadrant,axillary lymphonodus involvement,pathological type,clinical stage,B symptoms,serum LDH levels,treatment,CNS prevention and prognosis.Conclusion:1.The incidence of PBL seemed low,and most patients were female.The painless mass was the first clinical manifestation in most cases.The main pathological type was DLBCL.2.The bilateral breast involvement,serum ?2-MG level,IPI score are related to prognosis.The bilateral breast involvement,increased serum ?2-MG level,IPI scoring at least 2 are related to a worse prognosis than the unilateral breast involvement,normal serum ?2-MG level,and IPI scoring 0 ~ 1.