Clinical Characteristics And Prognosis Of Non-hodgkin’s Lymphoma Patients Complicated With Non-hematological Malignant Tumors

ObjectivesNon-Hodgkin lymphoma(NHL)with malignant solid tumors is a special type of multiple primary malignant tumors(MPMTs).This study aimed to determine the clinical characteristics,survival,and risk factors of these patients.MethodsOverall,97 MPMTs were recruited from consecutive 2,632 NHL patients diagnosed in Tianjin Medical University Cancer Institute and Hospital between January 1,2010 and May 31,2018.Among 97 patients with MPMTs,B-NHL occurred the most in these patients(94.8%,n=92),so patients with this pathological type were specially recruited for further study.MPMTs were classified into synchronous(n=21)and metachronous tumors(n=71)according to the time free to second tumor(TF2T)of 6 month.Furthermore,patients in the latter group were classified into the metachronous first group(n=27),and the metachronous second group(n=44)according to the time of the occurrence of NHL.Follow-up of 92 patients.The SPSS 22.0 software was used.ResultsOf these 92 patients,52(56.5%)were male and 40(43.6%)were female,with a male-to-female ratio of 1.3:1.The median age was 57.5 years at diagnosis of the primary tumor.The majority of patients were diagnosed with the first malignancy at the age <60 years,with a ratio of 2.8:1.Diffuse large B-cell lymphoma(DLBCL)was the most frequent histological lymphoma type.The digestive system was the commonest site affected by the solid cancer.21(22.8%)patients was in synchronous MPMTs group,71(77.2%)was in metachronous MPMTs group with the ratio of 1:3.4.27 was in the metachronous first group,which referred to NHL patients occurred as first primary tumor.44 was in the metachronous second group,which referred to NHL patients occurred as second primary tumor,with the ratio of 1:1.6.DLBCL was the most frequent histological type of lymphoma in all the three groups.In the metachronous first group,the respiratory system(33.3%)was the commonest site affected by solid cancer,whereas in the metachronous second group,the breast(22.7%)was the commonest site,In the synchronous tumor group,the top 1 sites were the digestive system(38.1%).The median follow-up of 92 patients was 13.5(range,0.3–72)months.In general,the 1-and 2-year survival rates were 86.5% and 70.5%,respectively.The overall survival(OS)rates of patients were 67.9% and 36.2% at 2 and 3 years,respectively,in the metachronous first group;73.8% and 73.8%,respectively,in the metachronous second group;and 68.1% and 56.7%,respectively,in the synchronous tumor group.For all patients,multivariate analysis revealed that age ≥60 years(HR 4.156,95% CI:1.506-11.469),female(HR 0.139,95%CI: 0.031-0.621),and involved nodal sites ≥3(HR 3.348,95%CI:1.269-8.834)were considered significant factors for OS.For patients in the metachronous first group,univariate analysis showed that there was significant better outcome for female patients,and patients with localized(Ann Arbor stage I-II)(p>0.05).But there were no significant prognostic factors in multivariate analysis.For patients in the metachronous second group,we found that univariate analysis showed that there was significant better outcome for patients younger than 60 years old regardless of primary cancer or sNHL(p<0.05).Female,the time free to second tumor(TF2T)≥50months,normal β2-MG level,IPI<2,rituximab combined to chemotherapy for OS(P>0.05).Multivariate analysis further demonstrated that age≥60years(HR 26.15,95% CI:12.60-263.84)and TF2T<50months(HR 0.20,95%CI: 0.04-1.01)were meaningful risk factors for OS.For patients in the synchronous MPMTs group,univariate analysis showed that there was significant better outcome for female patients(p>0.05).Conclusions 1.In this study,males were more likely to have MPMTs in NHL than females.Moreover,metachronous MPMTs were more frequent than synchronous MPMTs.DLBCL was the most frequent histological type of lymphoma in all the three groups.2.In this study,for NHL patients with MPMTs,the OS was shorter in NHL patients who developed a second tumor than in those who were diagnosed with solid cancer synchronously and second neoplasm after previous solid tumors after two years.3.In this study,for all patients,a multivariate analysis revealed that age ≥60 years male and involved nodal sites ≥3 were considered independent prognostic factors associated with survival.For sNHL,compared to de novo NHL,except the same prognostic factors,such as age,IPI in de novo NHL,the longer interval time(eg,TF2T≥50 months)was also one factor indicating a better survival time for sNHL.Rituximab may also improve the survival of sNHL patients.For patients in the metachronous first group and in the synchronous MPMTs group,more research is needed to determine the prognostic factors.4.In this study,for the metachronous tumor group,TF2 T was short in the first group than that in the second group.