Clinical Features And Prognostic Factors Of Primary Gastrointestinal Lymphoma

Background:Extranodal lymphoma(EL)was first proposed by Issacsson in 1983.Clinically,lymphomas in organs and tissues other than lymph nodes are also included.EL is almost non Hodgkin’s lymphoma(NHL),representing between 40% and 50% of NHL.Primary gastrointestinal lymphoma(PGIL),the most common extranodal non-Hodgkin lymphoma,with an incidence of 30% to 40% of EL,is a kind of rare and malignant tumor originated from the lymphatic tissue of gastrointestinal mucosa.Recently,the incidence of PGIL is increasing year by year,and can be induced by some factors,including chronic pathogenic microbial infections,autoimmune disease,and secondary immunologic disorder.The early clinical manifestations of PGIL are diverse,lack of specificity,and and occult.It is difficult to distinguish PGIL from other benign and malignant diseases of gastrointestinal tract.Therefore,the rate of missed diagnosis and misdiagnosis is high.The standard treatment for PGIL is still controversial,and there are different reports on the prognostic factors.Hence,early diagnosis,clarification of relevant adverse prognostic factors,and standardized treatment are of great significance to improve the prognosis of the disease in clinical work.Objective:To summarize the clinical manifestation,pathological features of PGIL and investigate their prognostic factors.Methods:The clinical data of 116 patients with PGIL from January 1,2012 to December31,2019 were collected and analyzed retrospectively.All patients in the group were clearly diagnosed by pathology,and the site of tumor invasion was determined by surgery and/or imaging examination,which met Dawson’s criteria.By consulting the electronic case,the clinical data of the enrolled patients were collected,including: age,gender,clinical manifestations,B symptoms,ECOG score,lactate dehydrogenase(LDH),β2 microglobulin(β2-MG),pathological type,clinical stage,International Prognostic Index(IPI)score,Ki67 expression and treatment methods.Checking the case and telephone follow-up to determine the patient’s survival status and prognosis.Overall survival(OS)was used to evaluate the prognostic survival,which was defined as the time from the date of diagnosis of the disease to death or the last follow-up.The data was analyzed by SPSS 25.0 software.The measurement data in the statistics were described by the median,the count data was expressed by percentage,and the chi-square test was used for comparison between groups.Prognostic and survival factors were analyzed by the Kaplan-Meier method,Log-rank test univariate analysis and Cox multivariate regression analysis.The P value <0.05 was considered statistically significant.Results:1.A total of 116 patients were included in this study,among these patients,65 were male and 51 were female,with an average diagnosed age of 58 years and the median diagnosed age of 59 years.2.PGIL has various clinical manifestations,and the most common is abdominal pain(35.3%),followed by distension(12.1%),stool habits or trait changes(7.8%),abdominal discomfort(6.9%),gastrointestinal bleeding(6.9%),acid reflux(6.0%),weight loss(5.2%).51 cases(43.9%)had symptoms of B: fever,night sweats and weight loss(body weight reduced by more than 10% within 6 months).3.Among the 60 patients with primary gastric lymphoma(PGL),the most frequent site was the gastric antrum,with an earlier stage.The initial diagnostic accuracy of gastroscopy and CT were 58.8% and 16.0%,respectively.Among the 50 patients with primary intestinal lymphoma(PIL),the most common site of onset was ileum,with a later stage.The initial diagnostic accuracy of colonoscopy and CT were38.2% and 22.7%,respectively.Under endoscopy,PGL tends to be ulcerative and PIL is mostly hyperplastic.4.105 patients were diagnosed as B-cell lymphoma,11 patients were diagnosed as T-cell lymphoma.Diffuse large B cell lymphoma(DLBCL)and mucosa associated lymphoid tissue(MALT)lymphoma were the most common pathological types.5.Compared with PGL,PIL mostly showed later clinical stage(P<0.001),higher IPI score(P=0.035),and higher LDH level(P=0.006).The 3-and 5-year OS of PGL patients were 82.0% and 67.8%,respectively;the 3-and 5-year OS of PIL patients were 54.2% and 47.8%,respectively.6.Univariate analysis revealed that age >60 years,IPI score ≥ 3,T cell phenotype,advanced Lugano stage,and intestinal lymphoma were predictors for poor prognosis.Multivariate analysis showed that pathological phenotype and Lugano stage were independent predictors for OS of patients with PGIL.Conclusions:1.PGIL is more common in middle-aged and elderly men,and abdominal pain is the first manifestation.DLBCL and MALT lymphoma are the most common pathological types.2.PGL usually occurs in the stomach,of which the antrum is the most common;PIL tends to occur in the small intestine,among which the ileocecal area is most common.Compared with PGL,PIL patients mostly showed later clinical stage,higher IPI scorem,and higher LDH level.3.Under endoscopy,PGL tends to be ulcerative and PIL is mostly hyperplastic.4.Univariate analysis revealed that age >60 years,IPI score ≥ 3,T cell phenotype,advanced Lugano stage,and intestinal lymphoma were predictors for poor prognosis.5.Multivariate analysis showed that pathological phenotype and Lugano stage were independent predictors for OS of patients with PGIL.