| Objective:This article aims to investigate the clinical features of patients with Primary Testis Diffuse Large B-cell Lymphoma(PT-DLBCL)and the prognostic factors affecting progression-free survival(PFS)and overall survival(OS)in a single center.Methods:A retrospective analysis of 29 hospitalized(through January 01,2010 to February 01,2020)patients with Primary testis diffuse large B-cell lymphoma in our Hospital were performed.The recorded clinical characteristics,laboratory results,pathological immunohistochemistry,Treatment regimen,efficacy,and survival status were analyzed.The diagnostic criteria were histopathology and immunohistochemistry of excised testicles were diagnosed as diffuse large B-cell lymphoma by more than 2 deputy chief physicians in the pathology department of our hospital.All cases were assessed by risk stratification using the IPI scoring system,staged by Ann Arbor staging,The efficacy of treatment were evaluated according to the evaluation criteria for malignant lymphoma(Lugano 2014 version).The prognostic factors including clinical features,laboratory results,pathological markers,and treatment were analyzed by univariate analysis and multivariate analysis.Kaplan Meier Log-rank test was used for univariate analysis,and COX Forward LR was used for multivariate analysis.Significant univariate analysis was included in multivariate analysis,the statistical significance of all tests is based on 0.05.Results:Among the 29 patients with PT-DLBCL,the median age of onset was 63 years old,the minimum age was 36 years old,the maximum age was 78 years old,and 7(24.14%)patients were older than or equal to 70 years old;27 cases had testicular or scrotal mass as the first symptom,2 cases had testicular swelling and pain as the first symptom;13(44.83%)patients,lesions were located on the left side 12 patients on the right side(41.38%),and 4 patients on both sides(13.79%).According to Ann Arbor staging,there were 17 patients(58.62%)in early stage and 12 patients in late stage(41.38%),As for IPI score,there were 19 patients(65.52%)in 1-2 group and 10 cases(34.48%)in 3-5 group.Among the 29 cases of PT-DLBCL,12 cases(41.38%)were(Germinal center B cell type in germinal center,17 cases(58.62%)were non-germ center B cell type,2 cases were treated by operation alone,21 cases were treated by operation combined with chemotherapy,6 cases were treated by operation combined with radiotherapy and chemotherapy.Overall survival evaluation: the median overall survival time(Overall survival,OS)was 55.2 months,and the OS rates of 1 year,3years and 5 years were 96.4%,63.9% and 54.8%,respectively.The median PFS was84.02 months,and the cumulative PFS rates of 1 year,3 years and 5 years were92.2%.Initial treatment effect: the overall response rate of initial treatment(Overall Response Rate,ORR)was 86.21%(25/ 29),and the complete remission rate(Complete remission,CR)of primary treatment was 65.52%(19/29).Among the27 patients who received further treatment after operation,6 patients were not treated with rituximab and 21 patients were treated with rituximab.The CR rate of patients with rituximab regimen was 71.43%(15/21),and the CR rate of patients without rituximab regimen was 66.67%(4/6),P>0.05.The ORR of newly treated patients with rituximab regimen was 90.45%(19/ 21),and the ORR of untreated rituximab regimens was 88.3%(5/6).The 3-year and 5-year cumulative OS rates of rituximab and untreated rituximab were 66.6%,66.6% and 83.3%,55.6%,respectively,P=0.720>0.05;and the 3-year cumulative PFS of rituximab and untreated rituximab were 95.0% and 83.3%,respectively.Among the 29 patients,3 patients had recurrence,all of them had contralateral testicular recurrence and no central nervous system recurrence.Univariate analysis showed that serum albumin,hemoglobin,platelet,location of focus,age and IPI score had influence on OS,while hemoglobin and platelet had influence on PFS.Multivariate analysis showed that age,location of lesion and surgical treatment alone were independent prognostic factors of OS in patients with primary testicular diffuse large B-cell lymphoma.Conclusion:1.The incidence of PT-DLBCL is low,the median age of onset was 63 years old,the minimum age was 36 years old,has a younger trend,the recurrence of the disease was mainly in the contralateral testis.2.serum albumin,hemoglobin,platelet,location of focus,age and IPI score were related to OS,while hemoglobin and platelet were related to PFS.Age ≥ 70 years old,bilateral testicular involvement and simple surgical treatment are independent risk factors for OS in patients with primary testicular diffuse large B-cell lymphoma,suggesting a poor prognosis. |
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