Study On The Clinical Features And Risk Factors Of The Patients With Non-Hodgkin Lymphoma Involving The Digestive System

Objective: Extranodal non-Hodgkin lymphoma(NHL)is common in the digestive system,especially in the gastrointestinal tract.There are less studies on the risk factors and predictors of the patients with NHL involving the digestive system.The clinical features and risk factors of NHL involving the digestive system was summarized and analyzed,to improve the awareness of disease.Method: The data of 260 adult patients with NHL were retrospectively reviewed at the First Affiliated Hospital of Guangxi Medical University from July 2012 to December 2017.All the patients were diagnosed as NHL by pathology in the 2016 WHO classification of tumors of haematopoietic and lymphoid tissues.Group with digestive system involvement was defined as biopsy of digestive system or PET/CT suggesting that lymphoma involving the organs of digestive system.Group without digestive system involvement was defined that there were not evidence of biopsy and PET/CT suggetting NHL involving the organs of digestive system.Sevevty-five patients were enrolled in the group with digestive system involvement and 185 patients were enrolled in the group without digestive system involvement.The clinical features and laboratory data of each group of them were analysed and compared.Results: Among the patients in the group with digestive system involvement,there were 55 males(73.3%)and 20 females(26.7%),the ratio of male to female was 2.75:1,the median age was 51 years.Fifty-six(74.7%)of them had gastrointestinal(GI)symptoms as the predominant symptoms.Forty-two patients were presented with abdominal pain(56.0%).The most common involved sites in group with digestive system involvement were stomach(56.0%),followed by the large intestine(21/75,28.0%),the small intestine(18/75,24.0%),liver(14/75,18.7%),pancreas(8/75,10.7%)and ileocecum(10/75,13.3%).There were no significant differences in age,gender,Ann Arbor clinical stage,International Prognostic Index(IPI)score,bone marrow involvement between group with digestive system involvement and group without digestive system involvement.Compared with the group without digestive system involvement,the patients in the group with digestive system involvement were more common with B-cell-derived lymphoma(93.3% vs77.3%,P=0.002)and presented of B symptoms(48.0% vs 33.0%,P=0.023).Anemia(54.7% vs 23.8%,P<0.001)and hypoproteinemia were more frequent and the positive rate of faecal occult blood test(18.7% vs 4.9%,P<0.001)was higher in the group with digestive system involvement.Compared with the group without digestive system involvement,TC and HDL-C levels were lower,serum and urine ?2-MG were higher in the group with digestive system involvement.In a logistic multivariate analysis,B-cell-derived lymphoma(OR=6.002,P=0.001),positive faecal occult blood test(OR=4.248,P=0.049),low levels of Hb(OR=0.984,P=0.023),low HDL-C levels(OR=0.353,P=0.043)and elevated levels of serum ?2-MG(OR=1.187,P=0.028)were independent risk factors of the NHL involving the digestive system.Conclusion: Patients of NHL involving the digestive system couldpresent with GI symptoms,B symptoms and anaemia.The most common involved sites in group with digestive system involvement were stomach.B-cell-derived lymphoma,positive faecal occult blood test,low levels of Hb,low HDL-C levels and elevated levels of serum ?2-MG were independent risk factors of the NHL involving the digestive system.