Chouhan Jay, Batra Sachin, Gupta Rohan, Guha Sushovan
Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas.
Department of Gastroenterology, Hepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas.
Cancer Med. 2016 Oct;5(10):2669-2677. doi: 10.1002/cam4.763. Epub 2016 Oct 1.
Gastrointestinal follicular lymphoma (GI-FL) is a rare extranodal variant of follicular lymphoma (FL) that has been increasingly reported in the literature. An especially indolent course is linked to the disease after a lack of observed patient death in past studies. However, overall survival (OS) and associated prognostic factors remain unclear. A large population-based database was utilized to identify demographic and clinicopathologic characteristics of GI-FL, along with survival differences among primary sites. The Surveillance, Epidemiology, and End Results Registry was used to identify GI-FL cases between the years of 1973 and 2012. Kaplan-Meier curves compared OS differences and Cox proportional hazard models analyzed prognostic factors. Final analysis included 1109 cases. Small intestinal cases, which included those with single-site and multi-segment involvement, were most common (63.6%) followed by gastric (18.2%) and colorectal cases (18.2%). Small intestinal GI-FL presented more frequently with grade I histology, and less often with grade III histology (P < 0.001 and P < 0.001, respectively). Small intestinal cases had better outcomes (5-year OS = 80.9%, P < 0.001) compared to cases involving the stomach (5-year OS = 52.7%) and colorectum (5-year OS = 71.5%). On multivariate analysis for predictors of mortality, small intestinal involvement predicted for better survival; hazard ratio (HR) 0.66 (95% CI: 0.51-0.85). Advanced age (≥66), grade (grade III), and stage (Ann Arbor Stage III/IV) predicted for mortality with HR 5.46 (95% CI: 3.80-7.84), 1.42 (95% CI: 1.10-1.83), 1.57 (95% CI: 1.15-2.16), respectively. GI-FL has poorer outcomes than previously suggested. Small intestinal involvement has a better prognosis. A possible biological basis for this will require further investigations in the future.
胃肠道滤泡性淋巴瘤（GI-FL）是滤泡性淋巴瘤（FL）一种罕见的结外变异型，在文献中的报道日益增多。在过去的研究中，由于未观察到患者死亡，该疾病病程特别惰性。然而，总生存期（OS）及相关预后因素仍不明确。本研究利用一个大型的基于人群的数据库来确定GI-FL的人口统计学和临床病理特征，以及不同原发部位的生存差异。使用监测、流行病学和最终结果登记处来识别1973年至2012年间的GI-FL病例。采用Kaplan-Meier曲线比较OS差异，并使用Cox比例风险模型分析预后因素。最终分析纳入1109例病例。小肠病例最为常见（63.6%），包括单部位和多节段受累病例，其次是胃（18.2%）和结肠直肠病例（18.2%）。小肠GI-FL更常表现为I级组织学，较少表现为III级组织学（分别为P < 0.001和P < 0.001）。与胃（5年OS = 52.7%）和结肠直肠（5年OS = 71.5%）受累病例相比，小肠病例预后更好（5年OS = 80.9%，P < 0.001）。在多因素分析死亡率预测因素时，小肠受累预示着更好的生存；风险比（HR）为0.66（95% CI：0.51 - 0.85）。高龄（≥66岁）、分级（III级）和分期（Ann Arbor分期III/IV期）预示着死亡，HR分别为5.46（95% CI：3.80 - 7.84）、1.42（95% CI：1.10 - 1.83）、1.57（95% CI：1.15 - 2.16）。GI-FL的预后比之前认为的更差。小肠受累预后较好。对此可能的生物学基础未来还需要进一步研究。
