Clinical Features And Prognosis Of 61 Patients With Primary Extranodal Diffuse Large B-cell Lymphoma

Background:Lymphoma is a hematological malignancy that originates in the lymphatic system and can affect any organ in the body other than the lymph nodes,present with a wide range of symptoms.Among them,diffuse large B-cell lymphoma(DLBCL)is the most common type of non-Hodgkin’s lymphoma,comprising 30% of all lymphomas.Patients usually present with a rapidly growing tumour mass in single or multiple,nodal or extranodal sites.DLBCLs can be involved in nodal and extranodal sites.Numerous studies have elucidated clinical differences between nodal and extranodal Lymphoma.Patients with extranodal lymphoma often have characteristics such as older age,lower tumor burden,and earlier clinical stage.In addition,the prognosis of extranodal and nodal DLBCL is controversial,some studies have found that there is no difference in the overal survival of extranodal DLBCL and node DLBCL,however,It was also reported that the prognosis of extranodal lymphoma is better than that in the nodule.This paper identified the histological type of DLBCL,and retrospectively analyzed the clinical features and prognosis of primary extranodal lymphoma in our hospital.Objective:Retrospective analysis of clinical features and prognosis of patients with primary extranodal DLBCL.Methods:From 1 January,2012 to 1 January,2018,114 patients with DLBCL were diagnosed at our hospital,excluded from 16 cases of primary mediastinal DLBCL,histologic transformation from indolent lymphoma to DLBCL,a previous history of malignancy,lost to follow-up.The clinical data and survival information of 61 patients with extranodal DLBCL were retrospective analyzed and compared with the clinical data of 37 patients with primary nodal DLBCL.The primary end‐point for statistical survival analysis was overall survival(OS),which was defined as the duration between the date of histological diagnosis and the date of death of any cause or date last follow-up.Statistical software R version 3.5.2.was used for data processing and statistical analysis,the count data presented by rate was compared with the chi‐square test.When the theoretical frequency was less than 5,the Fisher exact probability method was used.The test level was 0.05,all P values are were considered significant when <0.05.Factors independently affecting overall survival were identified using a Cox proportional hazards regression model.The single factor meaningful variables were put into the multivariate regression analysis model,the Kaplan-Meier survival analysis curve was drawn,and survival curves were compared with the log‐rank test.Results:1.The median age of primary extranodal DLBCL was 61(range,38-78 years),compared with 55(range,23-77 years)of primary nodal DLBCL.The mean age of patients with primary extranodal DLBCL was 59 years,compared with 54 of primary nodal DLBCL.2.98 patients with DLBCL,lymphoma node DLBCL accounted for 62.2%(61/98),and the extranodal DLBCL accounted for 37.8%(37/98).The common sites of primary extranodal DLBCL are 45.9%(28/61)in the gastrointestinal tract,11.5%(7/61)in the nasal cavity,and 8.1%(5/61)in the breast.3.Ann Arbor stage I/II accounted for 63.9%(39/61)in patients with primary extranodal DLBCL is statistically significant different compared 32.4%(12/37)in patients with primary nodal DLBCL,other clinical features such as age,gender,International Prognostic Index(IPI)score,ECOG score,Ki-67,β2 microglobulin,lactate dehydrogenase(LDH),achieved complete remission(CR),rituximab(R)and cell source,both(nodal and extranodal)were not statistically different.4.The 3-year overal survival of patients with primary nodal and extranodal DLBCL were 62.2% and 63.9%,respectively(p=0.9).5.Univariate analysis showed: age ≥ 60 years,IPI score > 2 points,ECOG score ≥ 2 points,Ann Arbor stage III / IV,β2 microglobulin increased,LDH increased,without using R,not CR is associated with poor prognosis in patients with extranodal DLBCL.6.Multivariate analysis showed that not using R and not reaching CR was an independent poor prognostic indicator for patients with primary extranodal DLBCL.Conclusion:1.The average age and median age of patients with extranodal DLBCL were greater than those in the nodules.2.Ann Arbor staging of primary extranodal DLBCL patients is focused on stage I / II.3.There was no significant difference in the 3-year overall survival between patients of primary extranodal DLBCL and nodal DLBCL.4.Univariate analysis showed: age ≥ 60 years,IPI score > 2 points,ECOG score ≥ 2 points,Ann Arbor stage III / IV,β2 microglobulin increased,LDH increased,not using R,not getting CR It is associated with poor prognosis in patients with extranodal DLBCL.5.Multivariate analysis showed that not using R and not getting CR was an independent poor prognostic factor in patients with primary extranodal DLBCL.