Analysis Of Clinical Features And Prognosis Of 76 Patients With Primary Extra-nodal Diffuse Large B-cell Lymphoma

Objective:Diffuse large B-cell lymphoma(DLBCL) is the most common non-Hodgkin lymphoma and is an aggressive malignancy with heterogeneous outcomes,which can occur in any organ outside the lymph nodes.DLBCL can be involved in nodal and extra-nodal sites.This paper identified the histological type of DLBCL,and retrospectively analyzed the clinical features and prognosis of primary extra-nodal lymphoma in our hospital.To explore the clinical features and prognosis of patients with primary extra-nodal DLBCL.Methods:The case data of 104 patients with DLBCL who were initially diagnosed after pathological and immunohistochemical examination in The First Affiliated Hospital of Fujian Medical University from January 1,2014 to December 31,2018 were collected,namely general clinical data(including sex,age,primary site,B symptom,IPI score,ECOG score,Ann Arbor clinical stage,LDH,ALB,Ki-67 positive rate,β2-microglobulin,tumor cell source,use of Rituximab,and overall survival time).The clinical data and survival status of 76 patients with primary extra-nodal DLBCL were analyzed retrospectively.The clinical data of 28 patients with primary nodal DLBCL were compared in the same period.SPSS22.0 was used for statistical analysis,the utilization rate of counting data was expressed,and chi-square test was used to compare the counting data.When the theoretical frequency was less than 5,Fisher exact probability method was used,and the difference was statistically significant.COX proportional risk regression model was used for factor analysis,univariate significant variables were put into the multivariate regression analysis model,Kaplan-meier survival analysis curve was drawn,and survival curve was compared and analyzed by log-rank test.Results:1.The median age of primary nodal DLBCL was 58 years old(range,21-77 years),with an average age of 55 years,and a male-to-female ratio of 0.75(12/16).While the median age of primary extra-nodal DLBCL was 55 years old(range,20-88 years),with an average age of 58 years,and a male-to-female ratio of 1.30(43/33).2.The common sites of primary extra-nodal DLBCL are gastrointestinal tract(26.3%),spine and bone(17.9%),central nervous system(14.5%),tonsil(9.2%),sinuses and nasopharynx(5.3%),joint and soft tissue(5.3%).3.The ECOG<2 score of patients with primary extra-nodal DLBCL accounted for35.5%(27/76),and the ECOG<2 score of patients with primary nodal DLBCL accounted for 67.8%(19/28).The difference between the two was statistically significant(p=0.003).There was no significant difference in other clinical features such as age,sex,international prognostic index(IPI)score,Ki-67,β 2-microglobulin,serum albumin level,lactate dehydrogenase(LDH)and tumor cell origin.4.The 5-year survival rates of patients with primary nodal and extra-nodal DLBCL were 74.7% and 61.7% respectively(P=0.159),and there was no statistical significance between them.5.Univariate analysis showed that IPI score >2 points,ECOG score ≥ 2 points and not using Rituximab were related to the poor prognosis of patients with primary extra-nodal DLBCL.6.Multivariate analysis showed that not using Rituximab was an independent indicator of poor prognosis in patients with primary extra-nodal DLBCL.Conclusion:The ECOG score of patients with primary extra-nodal DLBCL was higher than that of patients with primary nodal DLBCL.There was no significant difference in the5-year survival rate between primary nodal DLBCL and primary extra-nodal DLBCL.The most common site of primary extra-nodal DLBCL is gastrointestinal tract.IPI score >2 points,ECOG score ≥ 2 points and not using Rituximab were related to the poor prognosis of patients with primary extra-nodal DLBCL.Not using Rituximab was an independent indicator of poor prognosis in patients with primary extra-nodal DLBCL.