Analysis Of Clinical,Pathological Features And Prognostic Factors Of Primary Testicular Lymphoma

Objectives:The aims of this study were to:1.Explore the clinical and pathological features of PTL and analyze the relationship with the prognosis of PTL;2.To evaluate the effect of different treatment modes on the prognosis of PTL;3.To explore the expression of S1PR1 in pathological tissue of PT-DLBCL and analyze the relationship between the expression of S1PRl and prognosis of it,then to find out whether there is a possibility of S1P/S1PR1 as a potential therapeutic target for this disease.Through the above studies,we hope to raise the awareness and the level of diagnosis,treatment of this disease.By applying the research results to the clinic and assessing the prognosis,we can improve the quality of life of PTL patients and prolong their survival.Methods:A total of 52 patients with primary testicular lymphoma were treated in our hospital from May 1994 to March 2016 by searching from the medical record borrowing system of the Third Affiliated Hospital of Kunming Medical University(Yunnan Cancer Hospital).According to the inclusion and exclusion criteria for the screening of relevant cases,all of them meet the research criteria.According to the purposes of the study,the relevant data of the patients were collected and SPSS 20.0 software was used for statistical analysis.Results:52 cases of PTL patients' age ranged from 25 to 80 years,the median age was 60.4 years.There were 41 cases in phase IE and IV,accounting for 78.84%of all cases.Respectively,the median OS and PFS was 25.47 and 13.27months.ECOG scores were mostly 1 to 2 points and IPI scores were mostly 0 to 3 points.The first symptom of the disease was manifested as testicular enlargement or palpable mass.Only a few patients who were in late stage of disease had B symptoms.22 cases with other diseases associated with testis or adjacent tissues and organs.22 cases of infiltration with contralateral testis or adjacent tissue were found during the diagnosis and treatment.6 cases had pleural,abdominal or pelvic effusions.The main pathological type was B cells,-of which diffuse large B-cell lymphoma accounted for 42 cases.Univariate survival analysis revealed that late stage disease at the time of initial diagnosis,mass?70 mm,ECOG score ?2,adjacent tissue infiltration,presence of thoracic,abdominal and pelvic effusions,the higher than normal serum of LDH,Ki67?90%,not derive from B cell sources were poor prognostic factors of OS and PFS(P<0.05),non-GCB type and IPI score ?4 were poor prognostic factors of OS(P<0.05),and had no significant correlation with PFS.In this group of patients,4 cases were obtained by ultrasound guided testicular biopsy,48 cases were obtained by high testicular resection,12 cases were monotherapy,and 40 cases received combination therapy;44 cases received chemotherapy,and the median chemotherapy cycle was 4 cycles(1 to 10 cycles),chemotherapy program is mainly CHOP program,other programs also include:CHO,CO,L-GEMOX,VP,DICE,CHOP + bleomycin,EP and so on.Among the 10 patients receiving targeted therapy,the regimen was mainly R-adriamycin-based chemotherapy,and the median targeted treatment period was 3 cycles(1 to 6 cycles).Univariate survival analysis revealed that for PTL patients with similar staging and general conditions,a single treatment is a poor prognostic factor affecting their OS and PFS,and using an anthracycline-free chemotherapy regimen,the total chemotherapy cycles<6 were factors of poor prognosis in patients with IE/IIE stage.There was no significant correlation between the use of rituximab with OS and PFS.A total of 37 cases PT-DLBCLs were tested for S1PR1 expression,including 20 cases of positive and 17 cases of negative.37 cases of intranodal diffuse large B-cell lymphoma were selected randomly as a control group,including 11 cases of positive and 26 cases of negative.There was a statistically significant difference in the positive expression of S1PR1 between the two groups(x2=4.497,P=0.034),and the expression rate of S1PR1 in PT-DLBCL was higher.Univariate survival analysis revealed that S1PR1(+)was a poor prognostic factor for OS and PFS in patients with PT-DLBCL(P<0.05).Multivariate analysis found that the treatment mode(single treatment or comprehensive treatment)and source of germinal centers were independent prognostic factors affecting OS in PTL patients(P<0.05);The treatment mode(single treatment or comprehensive treatment)and expression of S1PR1 were independent prognostic factors of PFS in patients with PTL(P<0.05).Conclusions:1.PTL has no special clinical manifestations,hence it is easy for it to escape diagnosis or be misdiagnosed.In addition,its invasive ability is extremely strong,so the overall prognosis is extremely poor;2.Univariate survival analysis revealed that late stage disease at the time of initial diagnosis,mass?70 mm,ECOG score?2,IPI score?4,adjacent tissue infiltration,presence of thoracic,abdominal and pelvic effusions,the higher than normal serum of LDH,not derive from B cell sources,non-GCB type and Ki67?90%were poor prognostic factors of PTL.3.Comprehensive treatment should be used to treat this disease.For early patients,the use of anthracycline-containing chemotherapy regimens and chemotherapy cycles of?6 can improve the prognosis to some extent.Whether the use of rituximab can benefit PTL patients requires a large number of prospective experiments to confirm;4.The expression rate of S1PR1 in PT-DLBCL was higher than that in intranodal DLBCL,and its expression was related to the poor prognosis of PT-DLBCL.S1P/S1PR1 has the potential as a therapeutic target for the disease.