| Objective To explore the clinical characteristics,treatment projects,outcome and prognosis of primary extra-nodal diffuse large B-cell lymphoma and to provide more clinical experience and theoretical basis for patients with this type of diffuse large B-cell lymphoma.Methods A total of 186 patients diagnosed with primary extra-nodal DLBCL in Shandong Provincial Hospital from January 2013 to December 2018 were included in the study.The data of clinical features,pathological and immunohistochemical outcomes,treatment programs,curative effect are retrospective analyzed.Found out their clinical outcomes by telephone follow-up or other methods.The overall survival(OS)time was defined as the time from the first treatment after the patients was diagnosed to the death or the end of follow-up.The progression free survival(PFS)time was defined as the time from the initial diagnosis and treatment to any progression,recurrence,death,or the end of follow-up.Most of these patients were treated by CHOP/CHOPE chemotherapy regime(with or without rituximab),some patients received surgery before chemotherapy,a few of them received radiotherapy at the same time,very few patients undergo autologous hematopoietic stem cell transplantation(AHSCT).Statistical analysis applied SPSS22.0 software.Kaplan-Meier method for survival analysis,and calculated the 5-year overall survival rate and progression-free survival rate,the differences between groups were used Log-Rank test,the impact of various factors on survival was used Cox Regression proportional hazards model for analysis.defined P<0.05 as statistically significant difference.Result1.The total 5-year overall survival rate(OS)of 186 patients in the whole group was 66.9%,5-year progression-free survival rate(PFS)was 57.4%and the median follow-up time was 39 months.2.The gastrointestinal tract is the most common site(39.2%),followed by the Waldeyer's ring(25.8%)and the central nervous system(CNS,9.1%).The 5-year OS of them was 74.0%,85.1%,and 31.9%.The five-year PFS of them was 61.4%,72.4%and 33.7%respectively.3.The ratio of male-to-female was 1.16:1,with more male patients.The age ranged from 15 to 85 years,of which 72 patients(38.7%)were over 60 years old.The median age was 56 years and the average age was 54.4 years.4.The patients with IPI scores of 0-1(low risk),2(low and medium risk),3(high and medium risk),and 4(high risk)were 41.0%,26.3%,16.7%,and 15.1%,respectively.The patients with NCCN-IPI scores of 0-1(low risk),2-3(low and medium risk),4-5(high and medium risk),and?6(high risk)were 22.0%,85.0%,66.0%,and 12.0%,respectively.Survival prognostic analysis showed that NCCN-IPI was effective for high risk patients.5.The results of Hans immunotyping showed that Non-GCB type accounted for 65.1%,but compared with GCB type,there was no statistical difference between the 5-year OS(67.7%vs 65.8%)and PFS(57.4%vs 57.8%)results.6.Compared with four treatment schemes of chemotherapy,chemotherapy+radiotherapy,chemotherapy+surgery,chemotherapy+surgery+radiotherapy,there was no statistical difference in 5-year OS and PFS results among these;The 5-year OS of patients who used rituximab(74.3%vs 43.5%)and PFS(62.9%vs 39.5%)were higher than those who did not use rituximab,and their differences were statistically significant.7.Univariate analysis showed statistically significant differences in the effects of age,B symptoms,ECOG score,IPI score,NCCN-IPI score,albumin,LDH,serum ?2-microglobulin and extra-nodal site for overall survival rate.8.Multivariate analysis revealed that age,ECOG score,albumin,and LDH was the independent prognostic factors for overall survival rate.Conclusion1.The first three most common sites of extra-nodal DLBCL were the Webster's ring,the gastrointestinal tract,and the central nervous system.Among them,the prognosis of patients with Waldeyer's ring was the best,and the prognosis of patients with primary central nervous system was the worst.2.The NCCN-IPI score had certain value for the screening of high-risk patients and was a better prognostic stratification system.3.Univariate analysis showed that age,ECOG score,IPI score,NCCN-IPI score,albumin,lactate dehydrogenase,serum ?2-microglobulin and extra-nodal site could affect the survival prognosis of patients.4.Multivariate analysis showed that age,ECOG score,albumin and lactate dehydrogenase were independent prognostic factors. |
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