Clinical Features And Prognosis Analysis Of Primary Gastrointestinal Lymphoma

Objective:In this study,the clinical features and prognostic of PGIL were explored through a retrospective analysis of single-center primary gastrointestinal lymphoma(PGIL)in the First Hospital of Lanzhou University.Method:A total of 106 cases of PGIL patients were collected from September 1,2000 to December 31,2022 in the First Hospital of Lanzhou University.84 met the inclusion criteria.Collect the patient’s general information,clinical features,test indicators,calculation of systemic inflammatory response index(SIRI),imaging examination,electronic endoscopic performance,treatment mode,efficacy,etc.We staged the disease using Lugano and Ann Arbor stage.Prognostic scores and risk stratification were performed according to the International Prognostic Score(IPI).Overall survival(OS)refers to the date of diagnosis of pathological tissue biopsy to the date of death,with surviving patients being the follow-up cut-off date.The data were analyzed using SPSS 27.0 statistical software,the counting data were expressed as percentages,the normal distribution measurement data were expressed as mean ± standard deviation(X±S),the skewed distribution was expressed using the median/range,and the chisquare test or Fisher exact probability method was used for comparison between groups.The COX proportional hazards regression model was used for univariate survival analysis,and P<0.05 was included in the COX multivariate survival analysis.The Kaplan-Meier method was used to calculate survival rates and plot survival curves.The ROC curve was used to analyze SIRI’s ability to predict disease prognosis.Outcome:1.PGIL is more common in male patients,the age of onset is mainly middle-aged and elderly people(49-60 years old),and the stomach is the most common part of involvement;The clinical manifestations were mainly abdominal pain and abdominal distention;The cell source was mainly B cells,T cells were rare,the pathological type was mainly DLBCL,followed by MALT lymphoma;2.The clinical manifestations of 84 patients were mainly abdominal pain in 40cases(47.6%),followed by anemia in 39 cases(46.4%),abdominal pain with abdominal distension in 15 cases(17.9%),simple abdominal distension in 14 cases(16.7%),intestinal obstruction in 3 cases(3.6%),upper gastrointestinal bleeding in 2cases(2.4%),melena in 2 cases(2.4%),and diarrhea in 1 case(1.2%).The most common first department was general surgery with 41 cases(48.8%),followed by gastroenterology with 30 cases(35.7%).3.Among the 84 patients,46 patients(54.8%)had primary gastric lymphoma(PGL),33(39.3%)had primary intestinal lymphoma(PIL),and 5(6%)were in the gastrointestinal group.PGL involved 18 cases(39.1%),17 cases(36.9%),7 cases(15.2%),2 cases(4.3%),and 2 cases(4.3%).The microscopic findings were mainly 26cases(61.9%)of ulcerative lesions.PIL was affected in 14 cases(42.4%),8(24.2%)in the right colon,5(15.1%),4(12.1%),and 2(6%)in the left colon.Microscopically,10cases(71.4%)were mainly raised lesions.4.Among the 84 patients,there were 80 cases(95.2%)of B-cell phenotypic lymphoma and 4 cases of T-cell phenotype lymphoma(4.8%).Among them,there were49 cases(61.2%)of diffuse large B-cell lymphoma(DLBCL),29 cases(63%)of primary gastric DLBCL,15 cases(45.4%)of primary intestinal DLBCL,and 5 cases(10.2%)of gastrointestinal combined group DLBCL.There were 23 cases(27.3%)of mucosa-associated lymphoid tissue lymphoma(MALT),including 14 cases(30.4%)of gastric MALT lymphoma,9 cases(27.2%)of intestinal MALT lymphoma,and 2 cases were converted to DLBCL.Burkitt lymphoma(BL)4 cases and mantle cell lymphoma(MCL)2 cases.There were 3 cases of enteropathy-associated T-cell lymphoma(EALT)in T-cell phenotypic lymphoma,1 case of peripheral T-cell lymphoma,1 case of nonspecific type(PTCL-NOS),and 2 cases of NK/T-cell lymphoma.5.Among the 84 patients,23(27.3%)were in the LDH elevated group and 9(10.7%)in the β2-microglobulin(β2-MG)elevated group.Of the 27 patients tested for Helicobacter pylori(Hp)(32.1%),12(44.4%)were positive and 15 were negative(55.6%).Twenty-seven(32.4%)patients underwent bone marrow cell morphological examination,2 patients(7.4%)had bone marrow infiltrates,and 6 patients underwent bone marrow FISH examination.78(92.9%)of the 84 patients underwent CT and 6(7.1%)underwent PET-CT.6.6.Lugano staging was used in 84 patients,of which 21(26.2%)were stage I patients;26 patients(31.0%)were stage II.patients;18 patients(21.4%)in stage II.E;There were 20 patients with stage IV(21.4%).7.Among the 84 patients,58(69%)patients could be judged for efficacy,including30 patients(35.7%)with CR,11(13.1%)patients with PR,2 patients with SD(2.4%),and 15 patients with PD(17.9%).The overall response rate was 70.6%.Univariate analysis showed a statistically significant difference between LDH level,Lugano stage,treatment with rituximab,and IPI score and overall response rate at initial diagnosis(P<0.05).8.SIRI has a predictive effect on the prognosis of patients with PGIL(P<0.05),but its predictive ability is worse than that of IPI scores.The K-M univariate survival analysis showed that LDH,B symptoms,IPI prognostic score,SIRI,and lesion location were significantly correlated with prognosis,and the differences were statistically significant(P<0.05).The multivariate analysis of COX showed that B symptoms,IPI score,and SIRI were associated with prognosis,and the differences were statistically significant(P<0.05),indicating that SIRI≥3.0567,with B symptoms,IPI score,> 2were independent risk factors affecting the prognosis of PGIL.Conclusion:1.PGIL mainly occurs in middle-aged and elderly male patients(49-60 years old),and the stomach is the most common involved site.The main clinical manifestations were abdominal pain and abdominal distension.The main cell source was B cells,T cells were rare.The main pathological type was DLBCL,followed by MALT lymphoma.2.SIRI can predict the prognosis of PGIL patients,but its predictive ability is worse than IPI score;3.The prognostic factors included LDH level,B symptoms,Ann Arbor stage,IPI score,SIRI and lesion location.4.SIRI≥3.0567,B symptoms and IPI score > 2 are independent risk factors for the prognosis of PGIL.