Shen Ye, Ou Jinping, Wang Bingjie, Wang Lihong, Xu Junhui, Cen Xinan
Department of Hematology, Peking University First Hospital, Beijing, 100034, People's Republic of China.
Cancer Manag Res. 2021 Feb 4;13:1041-1052. doi: 10.2147/CMAR.S295671. eCollection 2021.
This study assessed the clinical characteristics of gastrointestinal bleeding (GIB), obstruction (GIO), and perforation (GIP) in patients with primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL) and the influence on long-term survival.
A retrospective analysis was performed of 148 patients with PGI-DLBCL admitted to Peking University First Hospital from August 1994 to May 2018. The clinical characteristics of GIB, GIO, and GIP before and after chemotherapy were recorded. The associated overall survival and progression-free survival were analyzed.
Among 148 patients, 56.8% had gastrointestinal complications (GICs), including GIB, GIO, GIP, and multiple complications, and 22.6% of them occurred after chemotherapy, mostly during the first 4 cycles. The most common clinical manifestations of patients with GICs were abdominal pain or discomfort (79.8%), hematemesis or melena (22.6%), and abnormal bowel habits (17.9%). Patients with Eastern Cooperative Oncology Group (ECOG) score ≥2, tumor mass ≥10 cm, or intestinal involvement had significantly higher risk of severe GICs as initial manifestations. Among 130 patients who received chemotherapy, B symptoms, tumor mass ≥10 cm, and Lugano stage (IIE, IV) strongly correlated with GICs after chemotherapy ( < 0.05). Rituximab did not increase the risk of GICs. GICs which occurred before or after chemotherapy reduced the objective response rate at the end of chemotherapy. The prognosis of patients was significantly worsened by GIP, GIB, or multiple complications after chemotherapy ( < 0.05). GIB at presentation or GIO before or after chemotherapy had no prognostic value (both > 0.05).
GICs adversely affect the quality of life, prolong the length of hospitalization, and shorten the long-term survival of patients with PGI-DLBCL.
本研究评估了原发性胃肠道弥漫性大B细胞淋巴瘤（PGI-DLBCL）患者胃肠道出血（GIB）、梗阻（GIO）和穿孔（GIP）的临床特征及其对长期生存的影响。
对1994年8月至2018年5月北京大学第一医院收治的148例PGI-DLBCL患者进行回顾性分析。记录化疗前后GIB、GIO和GIP的临床特征。分析相关的总生存和无进展生存情况。
148例患者中，56.8%发生胃肠道并发症（GICs），包括GIB、GIO、GIP及多种并发症，其中22.6%发生在化疗后，多在化疗的前4个周期。GICs患者最常见的临床表现为腹痛或不适（79.8%）、呕血或黑便（22.6%）及排便习惯异常（17.9%）。东部肿瘤协作组（ECOG）评分≥2、肿瘤肿块≥10 cm或肠道受累的患者以严重GICs作为初始表现的风险显著更高。在130例接受化疗的患者中，B症状、肿瘤肿块≥10 cm及卢加诺分期（IIE、IV）与化疗后GICs密切相关（<0.05）。利妥昔单抗未增加GICs的风险。化疗前后发生的GICs降低了化疗结束时的客观缓解率。化疗后发生GIP、GIB或多种并发症的患者预后显著恶化（<0.05）。初诊时的GIB或化疗前后的GIO无预后价值（均>0.05）。
GICs对PGI-DLBCL患者的生活质量产生不利影响，延长住院时间，并缩短长期生存。
