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Localized primary gastrointestinal diffuse large B cell lymphoma received a surgical approach: an analysis of prognostic factors and comparison of staging systems in 101 patients from a single institution.

Zhang S, Wang L, Yu D, Shen Y, Cheng S, Zhang L, Qian Y, Shen Z, Li Q, Zhao W - World J Surg Oncol (2015)

Bottom Line: Univariate factors correlated with inferior survival time were clinical parameters [age>60 years old, multiple extranodal/gastrointestinal involvement, elevated serum lactate dehydrogenase and β2-microglobulin, and decreased serum albumin], as well as pathological parameters (invasion depth beyond serosa, involvement of regional lymph node or adjacent tissue, Ki-67 index, and Bcl-2 expression).Major independent variables of adverse outcome indicated by multivariate analysis were multiple gastrointestinal involvement.IPI was able to further stratify the early-stage patients of Lugano classification into groups with distinct prognosis.

View Article: PubMed Central - PubMed

Affiliation: State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. annezhang1001@gmail.com.

ABSTRACT

Background: Diffuse large B cell lymphoma (DLBCL) represents the most common histological subtype of primary gastrointestinal lymphoma and is a heterogeneous group of disease. Prognostic characterization of individual patients is an essential prerequisite for a proper risk-based therapeutic choice.

Methods: Clinical and pathological prognostic factors were identified, and predictive value of four previously described prognostic systems were assessed in 101 primary gastrointestinal DLBCL (PG-DLBCL) patients with localized disease, including Ann Arbor staging with Musshoff modification, International Prognostic Index (IPI), Lugano classification, and Paris staging system.

Results: Univariate factors correlated with inferior survival time were clinical parameters [age>60 years old, multiple extranodal/gastrointestinal involvement, elevated serum lactate dehydrogenase and β2-microglobulin, and decreased serum albumin], as well as pathological parameters (invasion depth beyond serosa, involvement of regional lymph node or adjacent tissue, Ki-67 index, and Bcl-2 expression). Major independent variables of adverse outcome indicated by multivariate analysis were multiple gastrointestinal involvement. In patients unfit for Rituximab but received surgery, radical surgery significantly prolonged the survival time, comparing with alleviative surgery. Addition of Rituximab could overcome the negative prognostic effect of alleviative surgery. Among the four prognostic systems, IPI and Lugano classification clearly separated patients into different risk groups. IPI was able to further stratify the early-stage patients of Lugano classification into groups with distinct prognosis.

Conclusions: Radical surgery might be proposed for the patients unfit for Rituximab treatment, and a combination of clinical and pathological staging systems was more helpful to predict the disease outcome of PG-DLBCL patients.

No MeSH data available.


Related in: MedlinePlus

The RFS and OS curve according to Ann Arbor stage modified by Musshoff (a) and IPI score (b). The relapse-free survival (RFS) and overall survival (OS) curves according to Ann Arbor stage modified by Musshoff (a) and IPI score (b) show that these staging systems could define specific risk subgroups of patients with localized PG-DLBCL to some extent
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Fig1: The RFS and OS curve according to Ann Arbor stage modified by Musshoff (a) and IPI score (b). The relapse-free survival (RFS) and overall survival (OS) curves according to Ann Arbor stage modified by Musshoff (a) and IPI score (b) show that these staging systems could define specific risk subgroups of patients with localized PG-DLBCL to some extent

Mentions: As illustrated in Figs. 1 and 2, the staging systems varied from each other for defining specific risk subgroups. Ann Arbor staging with Musshoff modification could not further stratify the early-stage patients into different stages (stage I and stage II) (I, 5-year RFS, 86.8 ± 5.1 %; 5-year OS, 87.6 ± 5.3 % vs II, 5-year RFS, 77.9 ± 7.4 %; 5-year OS, 76.9 % ± 7.7 %, P = 0.423 and P = 0.428, respectively). IPI was able to define specific risk subgroups (low/low–intermediate (L–I)-risk and intermediate–high (I–H)/high-risk), but there was no prognostic difference between the low-risk subgroup and the L–I-risk group (5-year RFS and 5-year OS, P = 0.636 and P = 0.643, respectively), or between the high–intermediate (H–I)-risk subgroup and the high-risk group (5-year RFS and 5-year OS, P = 0.694 and P = 0.725, respectively). Using Lugano classification, the patients with advanced stage (IIE) had significantly shorter survival time than those with early stage (I and II) (IIE, 5-year RFS, 71.1 ± 11.0 %; 5-year OS, 76.0 ± 10.5 % vs I and II, 5-year RFS, 86.5 ± 4.5 %; 5-year OS, 85.4 ± 4.9 %, P = 0.039 and P = 0.044, respectively). Using Paris staging system, the patients in T3 and T4 showed no significant survival difference (T3, 5-year RFS, 71.3 ± 8.1 %; 5-year OS, 73.7 ± 8.0 % vs T4, 5-year RFS, 81.1 ± 9.9 %; 5-year OS, 80.4 ± 10.2 %, P = 0.661 and P = 0.695, respectively) (Table 4). Of note, according to IPI, Lugano early stage was grouped to IPI 0–2 (72 patients) and IPI 3–5 (10 patients) (Fig. 3). The latter had similar RFS and OS of the cases with Lugano late stage (P = 0.960 and P = 0.870, respectively). Thus, combination of clinical and pathological staging system was more efficient in classifying PG-DLBCL patients.Fig. 1


Localized primary gastrointestinal diffuse large B cell lymphoma received a surgical approach: an analysis of prognostic factors and comparison of staging systems in 101 patients from a single institution.

Zhang S, Wang L, Yu D, Shen Y, Cheng S, Zhang L, Qian Y, Shen Z, Li Q, Zhao W - World J Surg Oncol (2015)

The RFS and OS curve according to Ann Arbor stage modified by Musshoff (a) and IPI score (b). The relapse-free survival (RFS) and overall survival (OS) curves according to Ann Arbor stage modified by Musshoff (a) and IPI score (b) show that these staging systems could define specific risk subgroups of patients with localized PG-DLBCL to some extent
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
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getmorefigures.php?uid=PMC4536702&req=5

Fig1: The RFS and OS curve according to Ann Arbor stage modified by Musshoff (a) and IPI score (b). The relapse-free survival (RFS) and overall survival (OS) curves according to Ann Arbor stage modified by Musshoff (a) and IPI score (b) show that these staging systems could define specific risk subgroups of patients with localized PG-DLBCL to some extent
Mentions: As illustrated in Figs. 1 and 2, the staging systems varied from each other for defining specific risk subgroups. Ann Arbor staging with Musshoff modification could not further stratify the early-stage patients into different stages (stage I and stage II) (I, 5-year RFS, 86.8 ± 5.1 %; 5-year OS, 87.6 ± 5.3 % vs II, 5-year RFS, 77.9 ± 7.4 %; 5-year OS, 76.9 % ± 7.7 %, P = 0.423 and P = 0.428, respectively). IPI was able to define specific risk subgroups (low/low–intermediate (L–I)-risk and intermediate–high (I–H)/high-risk), but there was no prognostic difference between the low-risk subgroup and the L–I-risk group (5-year RFS and 5-year OS, P = 0.636 and P = 0.643, respectively), or between the high–intermediate (H–I)-risk subgroup and the high-risk group (5-year RFS and 5-year OS, P = 0.694 and P = 0.725, respectively). Using Lugano classification, the patients with advanced stage (IIE) had significantly shorter survival time than those with early stage (I and II) (IIE, 5-year RFS, 71.1 ± 11.0 %; 5-year OS, 76.0 ± 10.5 % vs I and II, 5-year RFS, 86.5 ± 4.5 %; 5-year OS, 85.4 ± 4.9 %, P = 0.039 and P = 0.044, respectively). Using Paris staging system, the patients in T3 and T4 showed no significant survival difference (T3, 5-year RFS, 71.3 ± 8.1 %; 5-year OS, 73.7 ± 8.0 % vs T4, 5-year RFS, 81.1 ± 9.9 %; 5-year OS, 80.4 ± 10.2 %, P = 0.661 and P = 0.695, respectively) (Table 4). Of note, according to IPI, Lugano early stage was grouped to IPI 0–2 (72 patients) and IPI 3–5 (10 patients) (Fig. 3). The latter had similar RFS and OS of the cases with Lugano late stage (P = 0.960 and P = 0.870, respectively). Thus, combination of clinical and pathological staging system was more efficient in classifying PG-DLBCL patients.Fig. 1

Bottom Line: Univariate factors correlated with inferior survival time were clinical parameters [age>60 years old, multiple extranodal/gastrointestinal involvement, elevated serum lactate dehydrogenase and β2-microglobulin, and decreased serum albumin], as well as pathological parameters (invasion depth beyond serosa, involvement of regional lymph node or adjacent tissue, Ki-67 index, and Bcl-2 expression).Major independent variables of adverse outcome indicated by multivariate analysis were multiple gastrointestinal involvement.IPI was able to further stratify the early-stage patients of Lugano classification into groups with distinct prognosis.

View Article: PubMed Central - PubMed

Affiliation: State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. annezhang1001@gmail.com.

ABSTRACT

Background: Diffuse large B cell lymphoma (DLBCL) represents the most common histological subtype of primary gastrointestinal lymphoma and is a heterogeneous group of disease. Prognostic characterization of individual patients is an essential prerequisite for a proper risk-based therapeutic choice.

Methods: Clinical and pathological prognostic factors were identified, and predictive value of four previously described prognostic systems were assessed in 101 primary gastrointestinal DLBCL (PG-DLBCL) patients with localized disease, including Ann Arbor staging with Musshoff modification, International Prognostic Index (IPI), Lugano classification, and Paris staging system.

Results: Univariate factors correlated with inferior survival time were clinical parameters [age>60 years old, multiple extranodal/gastrointestinal involvement, elevated serum lactate dehydrogenase and β2-microglobulin, and decreased serum albumin], as well as pathological parameters (invasion depth beyond serosa, involvement of regional lymph node or adjacent tissue, Ki-67 index, and Bcl-2 expression). Major independent variables of adverse outcome indicated by multivariate analysis were multiple gastrointestinal involvement. In patients unfit for Rituximab but received surgery, radical surgery significantly prolonged the survival time, comparing with alleviative surgery. Addition of Rituximab could overcome the negative prognostic effect of alleviative surgery. Among the four prognostic systems, IPI and Lugano classification clearly separated patients into different risk groups. IPI was able to further stratify the early-stage patients of Lugano classification into groups with distinct prognosis.

Conclusions: Radical surgery might be proposed for the patients unfit for Rituximab treatment, and a combination of clinical and pathological staging systems was more helpful to predict the disease outcome of PG-DLBCL patients.

No MeSH data available.


Related in: MedlinePlus