Clinical Characteristics And Prognosis Analysis Of Primary Intestinal Lymphoma

Background and PurposeExtra-nodal lymphoma(ENL)is a malignant lymphoma that occurs in lymphoid organs other than lymph nodes or non-lymphoid tissues.It can be found in the central nervous system,the Wei’s ring,the gastrointestinal tract,the breast,the testes,and the ovaries,throat,bone and other parts.The incidence of ENL accounts for approximately 40%-50% of non-Hodgkin lymphomas(NHL).The digestive tract is the most common site,accounting for 30-45% of ENL.Primary intestinal lymphoma(PIL)accounts for approximately 22-45% of primary gastrointestinal lymphoma(PGIL).PIL has significant differences in clinical features,pathological types,treatment and prognosis from primary gastric lymphoma(PGL).Previous studies have shown that their clinical manifestations and auxiliary examinations lack specificity,and pathological specimens are relatively difficult to obtain and are easily misdiagnosed.Treatment options include antibiotic therapy,surgery,radiation therapy,chemotherapy,monoclonal antibodies,and comprehensive treatment.Prognosis is associated with a variety of factors,such as local conditions of the tumor,immunophenotype,and international prognosis index(IPI)scores.At present,most studies on PIL are based on the gastrointestinal tract.PIL has been studied less,and the results reported in different literatures are inconsistent.Therefore,we do not have sufficient knowledge of the diagnosis,treatment and prognosis of PIL.This study collected the gender,age,pathological type,primary site,clinical stage,IPI score,ECOG score,serum β2 microtype of 62 PIL patients admitted to the First Affiliated Hospital of Zhengzhou University from January 2010 to January 2017.The globulin level,albumin level,lactate dehydrogenase level and other related data,the purpose is to analyze its clinical characteristics,the best treatment options and prognostic factors.Materials and MethodsA retrospective analysis of 62 patients with PIL admitted to the First Affiliated Hospital of Zhengzhou University from January 2010 to January 2017 was performed.The clinical and pathological features of the patients were collected,and the clinical features and prognostic factors were analyzed by chi-square test,Kaplan-Meier method,Log-rank test univariate analysis and Cox proportional hazard model multi-factor analysis.Results1.Clinical features: 40 males and 22 females,with a median age of 50 years.The most common site of invasion was 26 cases of ileocecal,followed by 17 cases of large intestine,13 cases of small intestine,and 6 cases of multiple intestinal sites.The most common clinical manifestation was 46 cases of abdominal pain.According to Lugano staging 26 cases of IE,36 cases of stage II.There were 52 cases of B cell-derived lymphoma and 10 cases of T-cell-derived lymphoma,the most common of which were diffuse large B-cell lymphoma in 37 cases.Among them,ECOG score ≥ 2 points in 14 cases,ECOG score < 2 points in 48 cases.There were 28 patients in the low-risk group with IPI score,25 patients in the low-intermediate risk group,8 patients in the middle-high-risk group,and 1 patient in the high-risk group.2.Laboratory indicators: 23 cases of elevated LDH(>245U / L)decreased hemoglobin(male <120g / L,female <110g / L)33 cases,albumin <30g / dL11 cases,β2 microglobulin increased 16 cases.Only 23 patients(57.5%)were diagnosed by digestive endoscopy.3.Treatment: The 5-year overall survival rate of this group was 69%.Five patients underwent surgery and 57 underwent chemotherapy.There was no significant difference between the combination of surgery and chemotherapy alone(P=0.335).There was a statistically significant difference between the operation group and the surgery group(P<0.001).There was no statistically significant difference between the combination of rituximab and no use in the surgical combination chemotherapy group.4.One-way analysis of variance showed that elevated serum LDH levels,elevated serum β2 microglobulin levels,hypoalbuminemia,intestinal perforation,T cell source,and surgery were poor prognostic risk factors for PIL.Multivariate analysis of variance showed that elevated T-cell lymphoma and LDH levels were independent prognostic factors for PIL.Conclusions1.PIL is a subtype of unique biological characteristics in extranodal lymphoma.2.Univariate analysis showed that elevated serum LDH levels,elevated serum β2 microglobulin levels,hypoalbuminemia,intestinal perforation,T cell source,and surgery were poor prognostic risk factors for PIL.Multivariate analysis showed that elevated T cell source and LDH levels were independent prognostic risk factors.3.Chemotherapy plays a critical role in the treatment of PIL and should be the treatment of choice.