Fan Xing, Zang Lu, Zhao Bing-Bing, Yi Hong-Mei, Lu Hai-Yang, Xu Peng-Peng, Cheng Shu, Li Qin-Yu, Fang Ying, Wang Li, Zhao Wei-Li
Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of General Surgery, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ann Transl Med. 2021 Oct;9(20):1542. doi: 10.21037/atm-21-4761.
The incidence of primary intestinal diffuse large B-cell lymphoma (PI-DLBCL) is much lower than primary gastric DLBCL, and large-scale analyses on the clinical characteristics, molecular features, therapeutic strategies, and risk stratification have been seldomly performed in PI-DLBCL.
To assess prognostic model development, 107 PI-DLBCL patients diagnosed before 2014 were studied for prognosis factors including different primary involved sites and treatment strategies. For internal validation, a non-random split sample set with 77 PI-DLBCL patients after 2014 was included for validation of the prognosis factors.
Patients with an ileocecal lesion presented with better survival time than those with non-ileocecal sites, with surgical resection significantly influencing the prognosis. Non-ileocecal patients who underwent surgery with lymphadenectomy had superior overall survival (OS) and progression-free survival (PFS) compared to those receiving surgery without lymphadenectomy or those not receiving (without) surgery. For ileocecal patients, surgery with or without lymphadenectomy resulted in better OS and PFS than those without surgery. For biomarker analysis, only BCL-2 >50% or Ki67 >80% on tumor cells indicated poor clinical outcome. In multivariate analysis, age, Eastern Cooperative Oncology Group (ECOG) score, and site of origin were independent prognostic factors for inferior OS in PI-DLBCL. A prognosis model was set up based on age, ECOG score, and site of origin, and validated well.
The prognosis in patients with PI-DLBCL with ileocecal involvement showed was better than those with non-ileocecal involvement. Surgical strategy can impact the clinical outcome of PI-DLBCL patients.
原发性肠道弥漫性大B细胞淋巴瘤（PI-DLBCL）的发病率远低于原发性胃弥漫性大B细胞淋巴瘤，针对PI-DLBCL的临床特征、分子特征、治疗策略及风险分层的大规模分析较少。
为评估预后模型的建立，对2014年前诊断的107例PI-DLBCL患者的预后因素进行研究，包括不同的原发受累部位和治疗策略。为进行内部验证，纳入2014年后的77例PI-DLBCL患者的非随机分割样本集，以验证预后因素。
回盲部病变患者的生存时间优于非回盲部病变患者，手术切除对预后有显著影响。与未行淋巴结清扫的手术患者或未接受手术的患者相比，行淋巴结清扫手术的非回盲部患者总生存期（OS）和无进展生存期（PFS）更佳。对于回盲部患者，无论是否行淋巴结清扫手术，其OS和PFS均优于未手术患者。对于生物标志物分析，仅肿瘤细胞上BCL-2>50%或Ki67>80%提示临床预后不良。多因素分析显示，年龄、东部肿瘤协作组（ECOG）评分及原发部位是PI-DLBCL患者OS较差的独立预后因素。基于年龄、ECOG评分及原发部位建立了预后模型，且验证效果良好。
PI-DLBCL累及回盲部患者的预后优于未累及回盲部患者。手术策略可影响PI-DLBCL患者的临床结局。
