Analysis Of Clinical Features And Prognostic Relevant Factors Of Intestinal Non-hodgkin Lymphoma

BackgroundIn recent years,the incidence of non-Hodgkin lymphoma(NHL)is increasing worldwide,especially extranodal lymphoma.Gastrointestinal tract is the most common site of extranodal lymphoma,but the overall incidence is low,in which intestinal lesions are rarer than stomach,so it is difficult to conduct a large-scale prospective study,and the best treatment strategy is still controversial.The clinical manifestations and endoscopic features of intestinal non-Hodgkin lymphoma are usually lack of specificity,so it is difficult to identify early,which can easily lead to missed diagnosis or misdiagnosis and delay the treatment of intestinal non-Hodgkin lymphoma.At the same time,intestinal non-Hodgkin lymphoma has rapid progress and poor prognosis,so it is particularly important for early and correct diagnosis and effective treatment of intestinal non-Hodgkin lymphoma.At present,the existing studies on gastrointestinal non-Hodgkin lymphoma reflect the characteristics of gastric lymphoma to a large extent and may not be applicable to intestinal lymphoma.Intestinal non-Hodgkin lymphoma includes primary and secondary intestinal lymphoma.most of the existing studies on intestinal lymphoma focus on primary intestinal lymphoma and lack of comprehensive analysis of all intestinal lymphomas.The guiding value for the diagnosis and treatment of intestinal non-Hodgkin lymphoma is limited.Therefore,this study included all patients with non-Hodgkin lymphoma involved in the intestinal tract,and retrospectively analyzed the clinical,endoscopic features and prognostic factors with diagnostic value,in order to improve the understanding of the disease and achieve early diagnosis and early treatment.ObjectiveThe purpose of this study was to explore the clinical features of patients with intestinal non-Hodgkin lymphoma,compare the differences between B-cell and T/NK cell lymphoma,and analyze the relevant factors affecting the prognosis of patients with intestinal non-Hodgkin lymphoma,in order to identify the specific disease features of intestinal non-Hodgkin lymphoma patients,so as to reduce missed diagnosis and misdiagnosis and improve the early recognition rate.And promote clinicians to predict the prognosis of patients through their early disease information.MethodsA total of 146 patients with intestinal non-Hodgkin lymphoma who were pathologically diagnosed and treated in the first affiliated Hospital of Zhengzhou University from January 1,2010 to June 30,2020 were collected.Collect the general data(sex,age),misdiagnosis,complications,pathological type,diagnosis mode,clinical stage,IPI score,lesion location,clinical manifestation,relevant laboratory examination index,imaging examination and digestive endoscopy results,treatment methods of all patients at the time of diagnosis,and follow up by telephone and consulting medical records until December 31,2020.The prognosis of patients was evaluated by Progression free survival(PFS).Through statistical analysis,the differences between intestinal B cells and T and NK cell lymphomas were compared,and the related factors affecting progression-free survival were screened out.SPSS 23.0 software was used to analyze the data and make statistical charts,the prognostic factors were analyzed by Kaplan-Meier method,the difference between the two groups was Log-rank tested,and the multi-factor analysis was carried out by Cox regression model.The survival curve was drawn by comparing the factors proved to be statistically significant or trend in single factor analysis.Results1.General characteristics:of the 146patients with intestinal non-Hodgkin lymphoma,120 cases(82.19%)were derived from B lymphocyte and 26 cases(17.81%)were derived from T/NK lymphocyte.The sex ratio of all patients was 2.32%.The median age of onset in patients with B-cell lymphoma was 57 years old,and the median age of onset in patients with T/NK-cell lymphoma was 45 years old,and the proportion of elderly patients was significantly higher than that of T/NK-cell lymphoma(P=0.035).2.Clinical manifestation:the clinical manifestation of the intestinal non-Hodgkin lymphoma is lack of specificity,the most common complaint symptom is abdominal pain(58.33%),and intestinal obstruction is the most common complication.Compared with B-cell lymphoma,B symptoms were more common in patients with T/NK-cell lymphoma,and were more likely to be complicated with intestinal perforation and gastrointestinal bleeding.3.Laboratory.examination:compared with intestinal B-cell lymphoma,patients with T/NK-cell lymphoma were more likely to have decreased albumin,increased C-reactive protein and EBV infection.4.Endoscopic features:the diagnosis rate of the first endoscopic biopsy in all patients was only 47.06%.The diagnosis rate of the first endoscopic biopsy in patients with B-cell lymphoma was significantly higher than that in T/NK-cell lymphomas.The morphology of endoscopic lesions was divided into protuberant type(58.82%),ulcerative type(14.71%),superficial phenotype(17.65%)and mixed type(8.82%),of which the most common type was protuberant type.Protuberant type(65.85%)was the most common in B-cell lymphoma,and ulcerative type(40.00%)was the most common in T/NK-cell lymphoma.5.prognosis:the median PFS of patients with intestinal non-Hodgkin lymphoma was 84(1-102)months,and the 1-year,3-year and 5-year progression-free survival rates were 75.17%,62.68%and 58.09%,respectively.The results of multivariate analysis showed that IPI≥2,the source of T and NK cells,intestinal perforation,intestinal obstruction and high CAR were independent risk factors for the prognosis of patients with intestinal non-Hodgkin lymphoma.Compared with operation alone,operation combined with chemotherapy could significantly improve the prognosis of patients(P<0.05).Conclusion1.It is difficult to identify intestinal non-Hodgkin lymphoma in the early stage,and the diagnosis rate of initial diagnosis is low.2.The perforation rate of intestinal T/NK-cell lymphomas was higher than that of B-cell lymphomas,and the prognosis was poor.In addition,IPI>2,intestinal obstruction,perforation and high CAR were all poor prognostic factors.For patients with the above adverse prognostic factors,active treatment and new treatment strategies are recommended.At the same time,the molecular mechanism leading to poor prognosis of intestinal non-Hodgkin lymphoma should be further studied.3.For patients with intestinal non-Hodgkin lymphoma surgery combined with chemotherapy can significantly improve PFS compared with chemotherapy alone.