Clinical and endoscopic features,and prognostic factors of primary small intestinal lymphoma

CHEN Xiao; WANG Lei; FAN Chongxi; LI Manhua; LI Jing; NING Shoubin; LI Bairong

doi:10.3969/j.issn.2097-1753.2024.05.007

Abstract：Objective To analyze the clinical and endoscopic features and prognostic factors of primary small intestinal lymphoma in order to improve the diagnostic efficiency and provide data for prognostic evaluation.Methods A retrospective analysis was conducted of the clinical data and endoscopic features of patients with primary small intestinal lymphoma who had accepted balloon-assisted enteroscopy(BAE)at our center between January 2008 and November 2022.Treatments and prognosis were evaluated after a detailed follow-up.The clinical manifestations and endoscopic features of small intestinal lymphoma patients were summarized according to pathological types and clinical stages.Also,the survival curve after diagnosis and poor prognosis(death)related factors were analyzed.Independent predictors of poor prognosis(death)were explored via the COX proportional-hazards model.Results Thirty-three patients with primary small intestinal lymphoma with follow-up results were included for analysis,with an average age of(55.8±1.6)years old.The clinical manifestations were abdominal pain(75.8％),gastrointestinal obstruction(48.6％),gastrointestinal bleeding(39.4％),and weight loss(45.5％).The pathological types of cases were B-cell lymphoma(28 cases,84.8％)and T-cell lymphoma(5 cases,15.2％).The former included 17 cases of diffuse large B-cell lymphoma(51.5％),6 cases of follicular cell lymphoma(18.2％),and 5 cases of mucosal associated lymphoid tissue lymphoma(MALT lymphoma)(15.2％).The diagnostic rate of endoscopic biopsy for B-cell lymphoma was relatively high(＞80％),while the rate of pathological diagnosis of MALT lymphoma and T-cell lymphoma was reduced with BAE-biopsy.Patients with advanced imaging staging had a significantly higher risk of death,and there was significant difference in median survival time between the two groups of patients(P＜0.05).Independent risk factors for death in patients with primary small intestinal lymphoma included moderate to severe anemia(HR=6.377,95％CI:1.245～32.657,P=0.026),T-cell lymphoma(HR=24.694,95％CI:2.978～204.767,P=0.003),and progression stage in imaging assessment(HR=6.923,95％CI:1.871～25.620,P=0.004).Conclusion BAE combined with biopsy is critical to the diagnosis of small intestinal lymphoma.Moderate to severe anemia,progression stage in imaging assessment,and T-cell lymphoma might be associated with poor prognosis for small intestinal lymphoma.