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Clinicopathologic analysis of localized nasal/paranasal diffuse large B-cell lymphoma.

Toda H, Sato Y, Takata K, Orita Y, Asano N, Yoshino T - PLoS ONE (2013)

Bottom Line: According to both Hans' and Choi's algorithms, the non-GCB type was predominant.Nevertheless, prognosis was good.In conclusion, although the non-GCB subtype is thought to show poor prognosis, in our study, the prognosis for localized nasal/paranasal DLBCL patients was good irrespective of subclassification.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.

ABSTRACT
Diffuse large B-cell lymphoma (DLBCL) comprises 2 molecularly distinct subgroups of non-germinal center B-cell-like (non-GCB) and germinal center B-cell-like (GCB) DLBCLs, with the former showing relatively poor prognosis. In the present study, we analyzed the clinicopathological features of 39 patients with localized nasal/paranasal DLBCL. Immunohistochemistry-based subclassification revealed that 11 patients (28%) were of the GCB-type according to Hans' algorithm and 11 (28%) were of the GCB-type according to Choi's algorithm. According to both Hans' and Choi's algorithms, the non-GCB type was predominant. Nevertheless, prognosis was good. Overall survival did not differ significantly between the GCB and non-GCB subgroups (Hans' algorithm: p = 0.57, Choi's algorithm: p = 0.99). Furthermore, the prognosis of localized nasal/paranasal DLBCL was better than that of other localized extranodal DLBCLs. The prognosis of extranodal DLBCL is usually considered poorer than that of nodal DLBCL. However, in our study, no difference was noted between patients with localized nasal/paranasal DLBCL and patients with localized nodal DLBCL. In conclusion, although the non-GCB subtype is thought to show poor prognosis, in our study, the prognosis for localized nasal/paranasal DLBCL patients was good irrespective of subclassification.

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Comparison of overall survival between localized nasal/paranasal DLBCL and localized adrenal, CNS, and testicular DLBCLs.
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pone-0057677-g006: Comparison of overall survival between localized nasal/paranasal DLBCL and localized adrenal, CNS, and testicular DLBCLs.

Mentions: DLBCL is the most frequent and aggressive lymphoma, representing a heterogeneous group that includes de novo large B-cell lymphomas, as well as transformed lymphomas from follicular or mucosa-associated lymphoid tissue lymphomas [11]. Recent studies have demonstrated that DLBCL can be further subclassified into 2 major prognostic categories according to Hans et al.: the GCB- type and the non-GCB- type [1], [2]. However, Hans’ algorithm has been superseded by a new algorithm devised by Choi et al., and results obtained using Choi’s algorithm closely correlate with those of gene expression profiling for predicting prognosis [5]. In general, the non-GCB- type of DLBCL is associated with a significantly poorer prognosis than the GCB- type [1]; however, it has recently been established that this may not be true for extranodal DLBCL. Patients with localized primary non-tonsillar oral DLBCL presented with a favorable clinical course despite having the non-GCB- type [6]. Similarly, in our study, the non-GCB- type of localized nasal/paranasal DLBCL was the dominant type following subclassification according to both algorithms, but the prognosis of these patients was good. Moreover, the prognosis of localized nasal/paranasal DLBCL was as good as that of primary cutaneous DLBCL [12] (p = 0.10) (Fig. 5) and was statistically better than that of other localized extranodal DLBCLs (CNS [13], testis [14], and adrenal gland [15]) (p = 0.0002, p = 0.0012, and p = 0.0044, respectively) (Fig. 6). Generally, extranodal non-GCB-like DLBCLs are characterized by poor prognosis, and the incidence of non-GCB- type DLBCLs among extranodal DLBCLs is 83–100%, although this value differs according to the organ of manifestation [16], [17], [18], [19]. According to previous reports, DLBCLs of the central nervous system [16], breast [17], stomach [20], leg type [21], testis [18], and intravascular type [19] are predominantly of the non-GCB- type, an observation consistent with the finding in our study of localized nasal/paranasal DLBCL cases. However, patients with CNS, breast, and testicular DLBCL exhibit poor prognosis, regardless of the localized disease [16], [17], [18], [22]. As shown for primary cutaneous B-cell lymphoma, findings of genes expression analysis suggest that primary non-leg-type cutaneous DLBCL and primary cutaneous DLBCL, leg type have expression profiles similar to those of GCB- type and non-GCB- type DLBCLs, respectively [23]. Therefore, primary non-leg-type cutaneous DLBCL is predominantly associated with an excellent prognosis [12], [24]. According to the recent World Health Organization (WHO) classification, subsets of DLBCLs arising in peculiar extranodal sites have been categorized as distinct disease subgroups (primary DLBCLs of the CNS, primary cutaneous DLBCLs, leg-type) or as distinct disease entities (primary mediastinal large B-cell lymphoma), on the basis of specific clinical and/or pathologic features [25], [26]. When the cases in our study are included, extranodal disease is common among DLBCL patients [27]. It is thought that there are important clinical differences between nodal and extranodal DLBCL and that the most reliable distinction can be made in patients with stage I disease. For these patients, extranodal DLBCL is independently associated with poor survival [27]. Therefore, we also compared the clinicopathological profiles of localized nasal/paranasal DLBCLs with localized nodal DLBCLs. This analysis showed that localized nasal/paranasal DLBCL was associated with good prognosis and no difference was noted in the prognosis compared with localized nodal DLBCL. In recent years, the use of rituximab has improved the prognosis of DLBCL patients, and CHOP (cyclophosphamide, adriamycin, vincristine, and prednisolone) therapy combined with rituximab (R-CHOP) is currently a standard chemotherapy for DLBCL [28]. In our study, no significant difference was noted in the number of patients treated with rituximab between localized nasal/paranasal DLBCL and localized nodal DLBCL patients (p = 0.24). Therefore, the prognosis of localized nasal/paranasal DLBCLs was favorable regardless of treatment with rituximab. In conclusion, the prognosis of localized nasal/paranasal DLBCL patients was good irrespective of the disease subclassification, although the non-GCB- type of DLBCLs are usually thought to be associated with a poor prognosis.


Clinicopathologic analysis of localized nasal/paranasal diffuse large B-cell lymphoma.

Toda H, Sato Y, Takata K, Orita Y, Asano N, Yoshino T - PLoS ONE (2013)

Comparison of overall survival between localized nasal/paranasal DLBCL and localized adrenal, CNS, and testicular DLBCLs.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3585191&req=5

pone-0057677-g006: Comparison of overall survival between localized nasal/paranasal DLBCL and localized adrenal, CNS, and testicular DLBCLs.
Mentions: DLBCL is the most frequent and aggressive lymphoma, representing a heterogeneous group that includes de novo large B-cell lymphomas, as well as transformed lymphomas from follicular or mucosa-associated lymphoid tissue lymphomas [11]. Recent studies have demonstrated that DLBCL can be further subclassified into 2 major prognostic categories according to Hans et al.: the GCB- type and the non-GCB- type [1], [2]. However, Hans’ algorithm has been superseded by a new algorithm devised by Choi et al., and results obtained using Choi’s algorithm closely correlate with those of gene expression profiling for predicting prognosis [5]. In general, the non-GCB- type of DLBCL is associated with a significantly poorer prognosis than the GCB- type [1]; however, it has recently been established that this may not be true for extranodal DLBCL. Patients with localized primary non-tonsillar oral DLBCL presented with a favorable clinical course despite having the non-GCB- type [6]. Similarly, in our study, the non-GCB- type of localized nasal/paranasal DLBCL was the dominant type following subclassification according to both algorithms, but the prognosis of these patients was good. Moreover, the prognosis of localized nasal/paranasal DLBCL was as good as that of primary cutaneous DLBCL [12] (p = 0.10) (Fig. 5) and was statistically better than that of other localized extranodal DLBCLs (CNS [13], testis [14], and adrenal gland [15]) (p = 0.0002, p = 0.0012, and p = 0.0044, respectively) (Fig. 6). Generally, extranodal non-GCB-like DLBCLs are characterized by poor prognosis, and the incidence of non-GCB- type DLBCLs among extranodal DLBCLs is 83–100%, although this value differs according to the organ of manifestation [16], [17], [18], [19]. According to previous reports, DLBCLs of the central nervous system [16], breast [17], stomach [20], leg type [21], testis [18], and intravascular type [19] are predominantly of the non-GCB- type, an observation consistent with the finding in our study of localized nasal/paranasal DLBCL cases. However, patients with CNS, breast, and testicular DLBCL exhibit poor prognosis, regardless of the localized disease [16], [17], [18], [22]. As shown for primary cutaneous B-cell lymphoma, findings of genes expression analysis suggest that primary non-leg-type cutaneous DLBCL and primary cutaneous DLBCL, leg type have expression profiles similar to those of GCB- type and non-GCB- type DLBCLs, respectively [23]. Therefore, primary non-leg-type cutaneous DLBCL is predominantly associated with an excellent prognosis [12], [24]. According to the recent World Health Organization (WHO) classification, subsets of DLBCLs arising in peculiar extranodal sites have been categorized as distinct disease subgroups (primary DLBCLs of the CNS, primary cutaneous DLBCLs, leg-type) or as distinct disease entities (primary mediastinal large B-cell lymphoma), on the basis of specific clinical and/or pathologic features [25], [26]. When the cases in our study are included, extranodal disease is common among DLBCL patients [27]. It is thought that there are important clinical differences between nodal and extranodal DLBCL and that the most reliable distinction can be made in patients with stage I disease. For these patients, extranodal DLBCL is independently associated with poor survival [27]. Therefore, we also compared the clinicopathological profiles of localized nasal/paranasal DLBCLs with localized nodal DLBCLs. This analysis showed that localized nasal/paranasal DLBCL was associated with good prognosis and no difference was noted in the prognosis compared with localized nodal DLBCL. In recent years, the use of rituximab has improved the prognosis of DLBCL patients, and CHOP (cyclophosphamide, adriamycin, vincristine, and prednisolone) therapy combined with rituximab (R-CHOP) is currently a standard chemotherapy for DLBCL [28]. In our study, no significant difference was noted in the number of patients treated with rituximab between localized nasal/paranasal DLBCL and localized nodal DLBCL patients (p = 0.24). Therefore, the prognosis of localized nasal/paranasal DLBCLs was favorable regardless of treatment with rituximab. In conclusion, the prognosis of localized nasal/paranasal DLBCL patients was good irrespective of the disease subclassification, although the non-GCB- type of DLBCLs are usually thought to be associated with a poor prognosis.

Bottom Line: According to both Hans' and Choi's algorithms, the non-GCB type was predominant.Nevertheless, prognosis was good.In conclusion, although the non-GCB subtype is thought to show poor prognosis, in our study, the prognosis for localized nasal/paranasal DLBCL patients was good irrespective of subclassification.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.

ABSTRACT
Diffuse large B-cell lymphoma (DLBCL) comprises 2 molecularly distinct subgroups of non-germinal center B-cell-like (non-GCB) and germinal center B-cell-like (GCB) DLBCLs, with the former showing relatively poor prognosis. In the present study, we analyzed the clinicopathological features of 39 patients with localized nasal/paranasal DLBCL. Immunohistochemistry-based subclassification revealed that 11 patients (28%) were of the GCB-type according to Hans' algorithm and 11 (28%) were of the GCB-type according to Choi's algorithm. According to both Hans' and Choi's algorithms, the non-GCB type was predominant. Nevertheless, prognosis was good. Overall survival did not differ significantly between the GCB and non-GCB subgroups (Hans' algorithm: p = 0.57, Choi's algorithm: p = 0.99). Furthermore, the prognosis of localized nasal/paranasal DLBCL was better than that of other localized extranodal DLBCLs. The prognosis of extranodal DLBCL is usually considered poorer than that of nodal DLBCL. However, in our study, no difference was noted between patients with localized nasal/paranasal DLBCL and patients with localized nodal DLBCL. In conclusion, although the non-GCB subtype is thought to show poor prognosis, in our study, the prognosis for localized nasal/paranasal DLBCL patients was good irrespective of subclassification.

Show MeSH
Related in: MedlinePlus