Clinical Characteristics And Outcomes Of 63 Patients With Extranodal Limited Stage Diffuse Large B Cell Lymphoma

Objective:The clinical data,laboratory indicators and survival data of patients with limited-stage extranodal diffuse large B cell lymphoma(DLBCL)were collected.To investigate the clinical features,prognosis and risk factors of primary extranodal limited-stage DLBCL(LS-DLBCL),the patients with primary nodal were used as controls LS-DLBCL.This will provide more clinical experience for patients with primary extranodal LS-DLBCL.Methods:A total of 101 patients who diagnosed with LS-DLBCL in the second hospital of Jilin University from January 1,2011 to July 1,2022 were retrospectively analyzed,including 63 primary extranodal DLBCL and 38 primary nodal DLBCL.The clinical data of 101 patients were collected,including gender,age,primary site,Ann Arbor stage,B symptoms,Eastern Cooperative Oncology Group(ECOG)score,underlying disease,source of tumor cells,hemoglobin(Hb),serum lactate dehydrogenase(LDH),serum β2-microglobulin(β2-MG),serum albumin(ALB),international prognostic index(IPI)score,stage-modified(SM)-IPI score,treatment method,Rituximab(R)and complete remission(CR)or not.All patients were followed up until December 1,2022 or death by telephone or review of medical records to detect the survival of patients.The primary end point are overall survival(OS)and progress-free survival(PFS).SPSS26.0 software was used for statistical analysis.COX proportional hazards regression model was used to analyze the influencing factors,and all the univariate significant variables were put into the multivariate regression analysis model.Kaplan-Meier survival analysis curve was drawn,and log-rank test was used to compare the survival curve.P<0.05 was considered statistically significant.Results:1.Primary extranodal LS-DLBCL accounted for 62.4% of LS-DLBCL.2.The most common site of primary extranodal LS-DLBCL was the gastrointestinal tract 34.9%,nasal cavity and sinus 20.6%,mediastinum 11.1%,thyroid gland 11.1%.The primary nodal LS-DLBCL were located in Waldeyer’s ring(71.1%)and lymph nodes(28.9%).3.There was no statistical differences in gender,age,Ann Arbor stage,B group symptoms,ECOG score,underlying disease,tumor cell origin,Hb,serum LDH,serum β2-MG,ALB,IPI score and SM-IPI score between primary extranodal and nodal LS-DLBCL patients.4.The 5-year and 10-year OS rate of 101 patients were 71.4% and 66.4%,and the 5-year and 10-year PFS rate were 59.8% and 43.8%.Patients with extranodal disease had an inferior PFS than patients with nodal involvement(P=0.031),with a5-year and 10-year PFS rates of 51.1% and 32.0% for extranodal patients compared with 74.0% and 63.4% for nodal patients.There were no significant differences in OS between nodal and extranodal LS-DLBCL(P=0.166),with a 5-year and 10-year OS rates of 66.3% and 56.8% for extranodal patients compared with both 78.6% for nodal LS-DLBCL patients.5.Univariate analysis of 63 patients with extranodal LS-DLBCL showed that serum β2-MG increased(P=0.002),serum LDH increased(P=0.043),SM-IPI score≥2(P=0.001),IPI score ≥2(P=0.017),failure to achieve CR(P=0.001)and not using of R(P=0.020)were associated with poor PFS.And serum β2-MG increased(P=0.025),SM-IPI score ≥2(P=0.045),failure to achieve CR(P=0.005)and not using of R(P=0.024)were associated with poor OS.6.Based on the univariate analysis of OS and PFS,all the factors with P < 0.05 were included in the COX proportional hazards regression model for multivariate analysis.The results showed that serum β2-MG increased(P=0.002),SM-IPI score ≥2(P=0.001),failure to achieve CR(P=0.001)and not using of R(P=0.001)were independent risk factors for poor PFS.And serum β2-MG increased(P=0.009),failure to achieve CR(P=0.002)and not using of R(P=0.013)were independent risk factors for poor OS.Conclusions:1.The most common site of primary extranodal LS-DLBCL is gastrointestinal tract.2.There were no significant differences in age,performance status,tumor burden and origin of tumor cells between primary nodal and extranodal LS-DLBCL patients.3.There is no significant difference in OS between primary nodal and extranodal LS-DLBCL patients,but the PFS of primary extranodal patients is significantly worse than primary nodal LS-DLBCL parients.4.Multivariate analysis showed that serum β2-MG increased,SM-IPI score ≥2,failure to achieve CR and not using of R are independent risk factors for PFS in patients with primary extranodal LS-DLBCL.And serum β2-MG increased,failure to achieve CR and not using of R are independent risk factors for OS.