Clinical Pathological Analysis Of Primary Extra-nodal Non-hodgkin’s Lymphoma

Background: Lymphoma is a kind of malignant tumor of hematologic system whichoriginates from lymph nodes or other lymphatic tissue. The primary originating site is one ofthe most important factors to impact the clinical biological behavior、treatment andprognosis of lymphoma. Lymphoma can be classified into primary extra-nodal lymphomaand primary nodal lymphoma，and the main pathological type of primary extra-nodallymphoma is Non-Hodgkin’s lymphoma. PE-NHL has its own characteristic compared withLNL on epidemiology、clinical pathological features and prognosis, and there are also somedifferences about the results reported by our country and foreign countries. The internationalprognostic index is obtained from the research based on the westerners whose incidence ofPE-NHL is very low. So some researches have been done to testify whether the IPI isapplicable for PE-NHL.Objective: Analysis the differences on epidemiology、clinical analysis and prognosisbetween PE-NHL and LNL. Discuss whether the international prognosis index is applicablefor PE-NHL and the prognostic factors of PE-NHL.Methods: A retrospective study was conducted in the first affiliated hospital of JilinUniversity,there were151patients with primary extra-nodal lymphoma and106patientswith primary lymph node lymphoma from2007/01/01to2011/12/31. We collect all thepatients’ information about age、gender、primary originating site、clinical manifestation、test results、clinical stage、international prognosis index、treatment and so on. We use SPSSversion17.0to analysis the clinical features and prognostic factors of primary extra-nodallymphoma.Result:(1) In all cases of257NHL,58.75%of them are primary extra-nodal lymphoma.The median age of PE-NHL is52, and the male/female ratio is1.16:1.（2）The most common primary extra-nodal sites are the stomach(30.36%)、nose andsinuses(19.87%)、Waldeyer’s ring (17.22%).（3）In all cases of PE-NHL, the most common subtype is diffuse large B-celllymphoma(DLBCL), followed by NK/T and extra-nodal marginal zone B-cell lymphoma o f mucosa-associated lymphoid tissue(MALT). And the most common subtype of primarylymph node lymphoma is diffuse large B-cell lymphoma(DLBCL), follicular lymphoma(FL), and angio-immunoblastic lymphoma(AITCL).（4）NK/T lymphoma is mainly shown in PE-NL, FL andAITCL are more common inLNL. The most common subtype of other extra-nodal sites is DLBCL, except nose and skin.Also, DLBCL is more likely shown in gastrointestinal tract and Waldeyers ring, NK/T iscommon in nose and MALT is mainly in gastrointestinal tract.（5）B-symptoms are reported in43.05%of PE-NHL patients and56.60%of LNL,there are significant differences. The incidence of bumps in PE-NHL and LNL aresimilar,24.50%,17.92%respectively.（6）The clinical stages are well-distributed in PE-NHL, but in LNL Ⅲ/Ⅳphases are in85.85%of106patients. So the clinical stage distributions are significantly different betweenthe two groups. The Ⅰ/Ⅱ phases ofPE-NHL which originate from nose are76.67%, whilegastrointestinal tract and Waldeyer’s ring are well-distributed. The low risk andlow-intermediate risk are70.87%in PE-NHL and51.89%in LNL respectively，which aresignificantly different。（8）There are18cases misdiagnosed in151PE-NHL, the error diagnosis ratio is11.92%. And the gastrointestinal tract is the most common site to be misdiagnosed.（9）The3-year overall survival rates for PE-NHL patients and NHL patients are63.8%and72.6%respectively. The3-year progression free survival rates for PE-NHL patients andNHL patients are39.5%and47.8%respectively. But there is no difference between the twogroups. The risk groups(low risk、low intermediate risk、high intermediate risk and high risk)can estimate the prognosis of PE-NHL well.（10）Some factors for example bump、ESR、LDH、β2microglobulin、numbers ofextra-nodal sites、pathological subtype、clinical stage、ECOG and the curative effect of firsttreatment can affect the PFS of PE-NHL. Through multiple factor analysis we concludethat bump、LDH、pathological subtype、ECOG and curative effect of first treatment are theprognostic factors for PFS of PE-NHL. Also, ESR、LDH、numbers of extra-nodal site、clinical stages、ECOG and the curative effect of first treatment are prognostic factors for OSof PE-NHL. And through multiple factor analysis,ESR、LDH、numbers of extra-nodal siteand curative effect of first treatment are the prognostic factors for OS of PE-NHL. Conclusion:（1） In our hospital, the morbidity, median age and the male/female ratio of PE-NHLare in accordance with the results reported by our country. But the morbidity is higher thanthe result released by abroad, also the median age is younger than abroad.（2）The most common primary extra-nodal sites are the stomach、nose and sinuses andWaldeyer’s tonsillar ring, which are also in accordance with the results released by home andabroad.（3）The most common subtype is diffuse large B-cell lymphoma (DLBCL), followedby NK/T and extra-nodal marginal zone B-cell lymphoma o f mucosa-associated lymphoidtissue(MALT), which is the same with the results reported by our country.（4）The incidence of B-symptoms is different between PE-NHL and LNL, but theincidence of bumps in PE-NHL and LNL are similar.（5）The clinical stage distributions are significantly different between PE-NHL andLNL, Ⅲ/Ⅳ phases are much more common in LNL. Theratio of low risk andlow-intermediate risk group are also significantly different between PE-NHL and LNL。（6）The misdiagnosis ratio is11.92%in our hospital.And the gastrointestinal tract isthe most common site to be misdiagnosed as gastric cancer.（7）Although there is no difference between PE-NHL and LNL in OS and PFS, theprognosis of PE-NHL is a little better than LNL. And the risk groups(low risk、lowintermediate risk、high intermediate risk and high risk) can estimate the prognosis ofPE-NHL well.（8）All the risk factors in IPI, except age, can be verified as the prognostic factors ofPE-NHL. And also bump、pathological subtype、curative effect of first treatment and ESRcan estimate the prognosis of PE-NHL.。...