Clinical Prognostic Analysis Of 49 Patients With Primary Intestinal B-cell Non-hodgkin Lymphoma

Objective To investigate the clinicopathological features,Rational treatment strategy and prognostic factors in patients with primary intestinal B-cell non-Hodgkin lymphoma.Method The data of 49 patients with primary intestinal B-cell non-Hodgkin lymphoma diagnosed at the First Affiliated Hospital of Guangxi Medical University from January 2009 to January 2017 was retrospectively analyzed.The Kaplan-Meier method was applied for survival analysis,and Log rank test was used for comparison between groups,and Cox regression model was used for multivariate analysis.Result1.Among the 49 patients: there were 29 males(59.18%)and 20 females(40.82%),the ratio of male to female was 1.45:1;26 patients(53.06%)were younger than 60 years,and 23(46.94%)were older than 60 years,median age was 57 years(18 to 88 years old).17 patients(34.69%)were found in intestinal lesions,13 patients(26.53%)in ileocecal lesions,12 patients(24.49%)in colonic lesions,and 7 patients(14.29%)in diffuse lesions.2.Clinical manifestations: 38 patients(77.55%)with abdominal pain,27patients(55.10%)in anemia,23 patients(46.94%)appeared weight loss,14patients(28.57%)had melena or bloody stool,8 patients(16.33%)in nausea and vomiting,8 patients(16.33%)appeared loss of appetite,3 patients(6.12%)had abdominal mass,and 19 patients(38.78%)showed B symptoms.16 patients(32.65%)had acute abdomen during the onset: 7 patients(14.29%)in intestinal obstruction,4 patients(8.16%)in intestinal perforation,3 patients(6.12%)had intussusception,1 patient(2.04%)had intestinal necrosis,and 1 patient(2.04%)had obstructive jaundice,among them 14 patients(28.57%)underwent surgical treatment to relieve symptoms.3.All patients were the source of non-Hodgkin lymphoma and B cell: 36patients(73.47%)with DLBCL,6 patients(12.24%)with MALT lymphoma,3patients with(6.12%)MCL,1 patient(2.04%)with FL,1 patient(2.04%)with PBL,and 1 patient(2.04)between Bukitt and diffuse large B-cell lymphoma,1patient(2.04%)of B-cell lymphoma failed to be further typed.4.The 1-year,2-year,3-year and 5-year ’ s overall survival rates of all patients were: 72.4%,64.8%,61.7%,61.7%and the average survival time was69.69±7.22(95%CI:55.54-83.85).5.Treatment methods: 13 patients(26.53%)in chemotherapy alone;19 patients(38.78%)in surgery combined with postoperative chemotherapy;12 patients(24.49%)in surgery alone,1-year and 3-year survival rates were 69.2%、94.1%、58.3%and 61.5%、77.6%、48.6% respectively,the difference was not statistically significant(P=0.071).The 1-year and 3-year survival rates of surgery and postoperative chemotherapy were significantly better than those of simple surgery(P=0.016).The 1-year and 3-year survival rates of surgery andpostoperative chemotherapy were better than those of chemotherapy alone.the difference was statistically significant(P=0.080).The 1-year and 3-year survival rates of patients with DLBCL in patients with simple surgery,postoperative chemotherapy and simple chemotherapy were 42.9%,92.9%,66.7% and 28.6%,70.7% and 55.6% respectively.Surgery combined postoperative chemotherapy for 1 year,3 year survival rate is highest.compared with surgery alone,difference have statistical significance(P=0.007),and compared with the pure chemotherapy,difference is not statistical difference(P=0.166).Among DLBCL patients receiving chemotherapy,the 1-year and 3-year survival rates of patients used rituximab and patients non-used rituximab were 87.4%,75.0% and 77.7%41.7%,respectively,and the difference was not statistically significant(P=0.081).6.Univariate analysis showed that levels of CA125,LDH,and β2-MG were elevated,IPI score was ≥3,and Lugano stage IIE-IV stage was a poor prognostic factor for survival in PIL patients(P = 0.005,0.003,0.004,0.000,0.014 respectively).Multivariate analysis showed that IPI score ≥ 3 was an independent prognostic factor affecting OS rate in this study(P =0.001,HR=14.80,95%CI:2.94-74.36).Conclusion1.Primary intestinal B-cell non-Hodgkin lymphoma occurs mostly in middle-aged and elderly men.Small intestine and ileocecal was the commonest site of lesion.The clinical manifestations of abdominal pain are the most common and lack specificity.2.The pathological type was mainly diffuse large B cell lymphoma,followed by mucosal lymphoid tissue lymphoma,and other pathological types were rare.3.Serum LDH,serum β 2-MG,CA125 and clinical stage are closely related to the prognosis of patients with PI-B-NHL,and IPI score is an independent prognostic factor affecting OS in patients with PI-B-NHL.4.PI-B-NHL treatment is not recommended in patients with simple operation,and should choose the therapeutic regimen including chemotherapy,whether to choose the surgery should be based on whether the patient’s endoscopy can be diagnosed and whether acute abdomen is combined.