Clinical observation of 62 patients with primary intestinal malignant lymphoma

LYU Chenglan; WANG Jing; XU Yueyi; XU Jingyan

doi:10.3969/j.issn.1009-0460.2024.05.012

Abstract：Objective To investigate the clinical features,diagnosis,treatment and prognostic factors of primary intestinal lymphoma(PIL).Methods Clinical medical records of PIL patients treated in Drum Tower Hospital Affiliated to the School of Medicine of Nanjing University from January 1,2018 to December 31,2022 were collected,including gender,age,hemoglobin,lactate dehydrogenase(LDH),Epstein-Barrvirus(EBV),tumor cell source,histologic type,IPI index and clinical stage,etc.,and were retrospectively summarized and analyzed.Results In this study,62 patients consistent with the diagnosis were collected,with a male to female ratio of 2.4∶1.The median age was 57 years.There were 42 cases in stage IV.Forty-seven patients underwent digestive endoscopy,and 40 patients were diagnosed with lymphoma by endoscopic biopsy.Colorectal and small intestine lymphoma were found in 27 and 32 cases,respectively.Sixty-one cases were non-Hodgkin lymphoma,of which 55 were B-cell origin and 41 were diffuse large B-cell lymphoma(DLBCL).All 62 patients received treatment,including 56 patients with systemic chemotherapy and 35 patients with surgery.During treatment,31 cases achieved complete response(CR),11 cases achieved partial response(PR),and 6 cases achieved stable disease(SD)and disease progression(PD).Median overall survival(OS)was not achieved in 62 patients,and 5-year survival rate was 66.64％.The median OS of patients＜50 years old was significantly better than that of patients ≥50 years old(P＜0.05).According to IPI,patients were divided into relatively low-risk group(IPI 0-2 points)and relatively high-risk group(IPI 3-5 points).The 5-year survival rates of the two groups were 78.18％and 50.69％,respectively,and the difference was statistically significant(P＜0.05).The median OS of PIL patients from B cell source and T cell source was not reached and 5.8 years,respectively,and the difference was statistically significant(P＜0.05).The 5-year survival rate of DLBCL patients was 77.69％.The prognosis of patients with EBV viremia was worse(P＜0.05).The median OS of patients treated with chemotherapy combined with surgery(26 cases)and chemotherapy alone(32 cases)was not reached,and the difference was not statistically significant(P＞0.05).Multivariate Cox analysis showed that T cell source and Epstein-Barr viremia were independent prognostic factors of OS(P＜0.05).Conclusion PIL is prone to male patients.PIL happens more frequent in intestine than in coloretum.Non-Hodgkin's lymphoma specifically DLBCL constitutes most PIL.Most patients can be diagnosed by biopsy specimen acquire through digestive endoscopy.Most patients need chemotherapy to achieve CR or PR.Besides,T lymphocyte origin and EBV viremia are poor prognostic factors.The surgery does not deteriorate patients'survival.