Liu Xiao-Hong, Chen Gong, Cao De-Dong, Liu Hui, Ke Xiao-Kang, Hu Yu-Gang, Tan Wei, Ke Dong, Xu Xi-Ming
Department of Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei Province, China.
Department of Hematology, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei Province, China.
World J Gastrointest Oncol. 2024 Nov 15;16(11):4409-4423. doi: 10.4251/wjgo.v16.i11.4409.
Aggressive primary gastrointestinal non-Hodgkin lymphoma (PGINHL) is an uncommon and heterogeneous group of lymphoid malignancies, that differs from indolent lymphoma and has a high incidence of severe gastrointestinal complications (GICs).
To investigate and compare the clinicopathological characteristics, treatments and outcomes in the GICs and No-GICs group with aggressive PGINHL.
This retrospective analysis was performed on aggressive PGINHL patients between January 2013 and December 2021 at our hospital. The independent influence factors of GICs were obtained by univariate and multivariate Logistic regression analysis, the selected variables significantly related to GICs were selected as the final predictors to construct nomogram. Kaplan-Meier curves further analyzed the survival of patients in GICs and No-GICs groups. Survival analysis of GICs group was performed using Cox regression.
We focused on 124 aggressive PGINHL cases, which had a relatively high incidence 48.4% (60/124 cases) of GICs, the most common histological type in GICs group was diffuse large B-cell lymphoma (DLBCL) ( = 49, 81.7%). In the GICs group, small intestine was the most common anatomic site of lesion (43.3%), followed by large intestine (31.7%), and then stomach and esophagus (25.0%). Multivariate Logistic regression analysis showed that the independent risk factors for GICs were the small intestine [odd ratio (OR) = 3.33; 95% confidence interval (CI): 1.47-9.41; = 0.009), aggressive B-cell (OR = 0.09; 95%CI: 0.01-0.83; = 0.033), maximum tumor diameter (OR = 1.25; 95%CI: 1.07-1.47; = 0.005), invaded deep serous layer (OR = 3.38; 95%CI: 1.24-9.19; = 0.017). We developed a nomogram to predict risk of GICs in aggressive PGINHL patients based on independent risk factors. The value of area under curve calculated by receiver operating characteristic curve was 0.815, and calibration curve and decision curve analysis further indicated that the prediction effect was superior. The majority of patients with GICs were given combination therapy (chemotherapy combined with surgery or radiation). Event-free survival and overall survival in GICs group were no worse than those in the No-GICs group.
The complication rate of GICs in patients with aggressive PGINHL was relatively high, particularly in PGI-DLBCL. The independent risk factors for GICs were the small intestine, PGI-TNKL, bulky tumor, and depth of invasion. A combination treatment, involving surgery, improved survival in the GICs group.
侵袭性原发性胃肠道非霍奇金淋巴瘤（PGINHL）是一组罕见且异质性的淋巴系统恶性肿瘤，与惰性淋巴瘤不同，且严重胃肠道并发症（GICs）发生率高。
研究并比较侵袭性PGINHL患者中发生GICs组与未发生GICs组的临床病理特征、治疗方法及预后。
对2013年1月至2021年12月我院收治的侵袭性PGINHL患者进行回顾性分析。通过单因素和多因素Logistic回归分析得出GICs的独立影响因素，将与GICs显著相关的变量作为最终预测因子构建列线图。采用Kaplan-Meier曲线进一步分析GICs组和未发生GICs组患者的生存情况。对GICs组进行Cox回归生存分析。
我们纳入了124例侵袭性PGINHL病例，GICs发生率相对较高，为48.4%（60/124例），GICs组最常见的组织学类型为弥漫性大B细胞淋巴瘤（DLBCL）（=49，81.7%）。在GICs组中，小肠是最常见的病变解剖部位（43.3%），其次是大肠（31.7%），然后是胃和食管（25.0%）。多因素Logistic回归分析显示，GICs的独立危险因素为小肠[比值比（OR）=3.33；95%置信区间（CI）：1.47 - 9.41；=0.009]、侵袭性B细胞（OR = 0.09；95%CI：0.01 - 0.83；=0.033）、最大肿瘤直径（OR = 1.25；95%CI：1.07 - 1.47；=0.005）、侵犯深层浆膜层（OR = 3.38；95%CI：1.24 - 9.19；=0.017）。我们基于独立危险因素绘制了列线图，以预测侵袭性PGINHL患者发生GICs的风险。通过受试者工作特征曲线计算的曲线下面积值为0.815，校准曲线和决策曲线分析进一步表明预测效果良好。大多数GICs患者接受了联合治疗（化疗联合手术或放疗）。GICs组的无事件生存期和总生存期不低于未发生GICs组。
侵袭性PGINHL患者中GICs的发生率较高，尤其是在PGI-DLBCL中。GICs的独立危险因素为小肠、PGI-TNKL、肿瘤体积大及侵犯深度。联合手术治疗可改善GICs组患者的生存情况。
