Clinical features and outcomes of diffuse large B-cell lymphoma based on nodal or extranodal primary sites of origin:Analysis of 1,085 WHO classified cases in a single institution in China
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摘要
Objective: To explore the clinicobiologic features and outcomes of diffuse large B-cell lymphoma(DLBCL)patients in China according to the primary site.Methods: A total of 1,085 patients diagnosed with DLBCL in National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College during a 6-year period were enrolled. Their clinical characteristics and outcomes were analyzed according to the primary site.Results: In the 1,085 patients, 679(62.6%) cases were nodal DLBCL(N-DLBCL) and 406 cases(37.4%) were extranodal DLBCL(EN-DLBCL). The most common sites of N-DLBCL were lymphonodus(64.8%), Waldeyer's ring(19.7%), mediastinum(12.8%) and spleen(2.7%), while in EN-DLBCL, stomach(22.4%), intestine(16.0%),nose and sinuses(8.9%), testis(8.4%), skin(7.9%), thyroid(6.9%), central nervous system(CNS)(6.4%), breast(5.7%), bone(3.4%), and salivary gland(2.7%) were most common. N-DLBCL patients tend to present B symptoms, bulky disease, and elevated LDH more often, while age >60 years, extranodal sites >1, Ann Arbor stage I or II, bone marrow involvement, and Ki-67 index >90% were usually seen in EN-DLBCL. The 5-year overall survival(OS) rate and progression-free survival(PFS) rate for all patients were 62.5% and 54.2%. The 5-year OS rate for patients with N-DLBCL and EN-DLBCL were 65.5% and 56.9%(P=0.008), and the 5-year PFS were57.0% and 49.0%(P=0.020). Waldeyer's ring originated DLBCL possessed the highest 5-year OS rate(83.6%) and PFS rate(76.9%) in N-DLBCL. The top five EN-DLBCL subtypes with favorable prognosis were stomach,breast, nose and sinuses, lung, salivary gland, with 5-year OS rate: 70.3%, 69.6%, 69.4%, 66.7% and 63.6%,respectively. While CNS, testis, oral cavity and kidney originated EN-DLBCL faced miserable prognosis, with 5-year OS rate of 26.9%, 38.2%, and 42.9%.Conclusions: In our study, primary sites were associated with clinical characteristics and outcomes. Compared with EN-DLBCL, N-DLBCL had better prognosis.
Objective: To explore the clinicobiologic features and outcomes of diffuse large B-cell lymphoma(DLBCL)patients in China according to the primary site.Methods: A total of 1,085 patients diagnosed with DLBCL in National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College during a 6-year period were enrolled. Their clinical characteristics and outcomes were analyzed according to the primary site.Results: In the 1,085 patients, 679(62.6%) cases were nodal DLBCL(N-DLBCL) and 406 cases(37.4%) were extranodal DLBCL(EN-DLBCL). The most common sites of N-DLBCL were lymphonodus(64.8%), Waldeyer's ring(19.7%), mediastinum(12.8%) and spleen(2.7%), while in EN-DLBCL, stomach(22.4%), intestine(16.0%),nose and sinuses(8.9%), testis(8.4%), skin(7.9%), thyroid(6.9%), central nervous system(CNS)(6.4%), breast(5.7%), bone(3.4%), and salivary gland(2.7%) were most common. N-DLBCL patients tend to present B symptoms, bulky disease, and elevated LDH more often, while age >60 years, extranodal sites >1, Ann Arbor stage I or II, bone marrow involvement, and Ki-67 index >90% were usually seen in EN-DLBCL. The 5-year overall survival(OS) rate and progression-free survival(PFS) rate for all patients were 62.5% and 54.2%. The 5-year OS rate for patients with N-DLBCL and EN-DLBCL were 65.5% and 56.9%(P=0.008), and the 5-year PFS were57.0% and 49.0%(P=0.020). Waldeyer's ring originated DLBCL possessed the highest 5-year OS rate(83.6%) and PFS rate(76.9%) in N-DLBCL. The top five EN-DLBCL subtypes with favorable prognosis were stomach,breast, nose and sinuses, lung, salivary gland, with 5-year OS rate: 70.3%, 69.6%, 69.4%, 66.7% and 63.6%,respectively. While CNS, testis, oral cavity and kidney originated EN-DLBCL faced miserable prognosis, with 5-year OS rate of 26.9%, 38.2%, and 42.9%.Conclusions: In our study, primary sites were associated with clinical characteristics and outcomes. Compared with EN-DLBCL, N-DLBCL had better prognosis.
Objective: To explore the clinicobiologic features and outcomes of diffuse large B-cell lymphoma(DLBCL)patients in China according to the primary site.Methods: A total of 1,085 patients diagnosed with DLBCL in National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College during a 6-year period were enrolled. Their clinical characteristics and outcomes were analyzed according to the primary site.Results: In the 1,085 patients, 679(62.6%) cases were nodal DLBCL(N-DLBCL) and 406 cases(37.4%) were extranodal DLBCL(EN-DLBCL). The most common sites of N-DLBCL were lymphonodus(64.8%), Waldeyer's ring(19.7%), mediastinum(12.8%) and spleen(2.7%), while in EN-DLBCL, stomach(22.4%), intestine(16.0%),nose and sinuses(8.9%), testis(8.4%), skin(7.9%), thyroid(6.9%), central nervous system(CNS)(6.4%), breast(5.7%), bone(3.4%), and salivary gland(2.7%) were most common. N-DLBCL patients tend to present B symptoms, bulky disease, and elevated LDH more often, while age >60 years, extranodal sites >1, Ann Arbor stage I or II, bone marrow involvement, and Ki-67 index >90% were usually seen in EN-DLBCL. The 5-year overall survival(OS) rate and progression-free survival(PFS) rate for all patients were 62.5% and 54.2%. The 5-year OS rate for patients with N-DLBCL and EN-DLBCL were 65.5% and 56.9%(P=0.008), and the 5-year PFS were57.0% and 49.0%(P=0.020). Waldeyer's ring originated DLBCL possessed the highest 5-year OS rate(83.6%) and PFS rate(76.9%) in N-DLBCL. The top five EN-DLBCL subtypes with favorable prognosis were stomach,breast, nose and sinuses, lung, salivary gland, with 5-year OS rate: 70.3%, 69.6%, 69.4%, 66.7% and 63.6%,respectively. While CNS, testis, oral cavity and kidney originated EN-DLBCL faced miserable prognosis, with 5-year OS rate of 26.9%, 38.2%, and 42.9%.Conclusions: In our study, primary sites were associated with clinical characteristics and outcomes. Compared with EN-DLBCL, N-DLBCL had better prognosis.
引文
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7.Rosenwald A,Wright G,Chan WC,et al.The use of molecular profiling to predict survival after chemotherapy for diffuse large-B-cell lymphoma.NEngl J Med 2002;346:1937-47.
8.Aoki R,Karube K,Sugita Y,et al.Distribution of malignant lymphoma in Japan:analysis of 2260 cases,2001-2006.Pathol Int 2008;58:174-82.
9.Yang QP,Zhang WY,Yu JB,et al.Subtype distribution of lymphoma in Southwest China:analysis of 6,382 cases using WHO classification in a single institution.Diagn Pathol 2011;6:77.
10.Schmitz R,Wright GW,Huang DW,et al.Genetics and pathogenesis of diffuse large b-cell lymphoma.N Engl J Med 2018;378:1396-407.
11.Edge SB,Byrd DR,Compton CC,et al.AJCCCancer Staging Manual.7th Edition.New York:Springer,2010.
12.Hans CP,Weisenburger DD,Greiner TC,et al.Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry of diffuse using a tissue microarray.Blood 2004;103:275-82.
13.International Non-Hodgkin’s Lymphoma Prognostic Factors Project.A predictive model for aggressive non-Hodgkin’s lymphoma.N Engl J Med 1993;329:987-94.
14.Sun J,Yang Q,Lu Z,et al.Distribution of lymphoid neoplasms in China:analysis of 4,638 cases according to the World Health Organization classification.Am JClin Pathol 2012;138:429-34.
15.Swerdlow SH,Campo E,Pileri SA,et al.The 2016revision of the World Health Organization classification of lymphoid neoplasms.Blood 2016;127:2375-90.
16.Yao S,Li J,Yao Z,et al.Extranodal involvement in young patients with diffuse large B-cell lymphoma:distribution,prognostic value and treatment options.Chin J Cancer Res 2017;29:57-65.
17.Urruticoechea A,Smith IE,Dowsett M.Proliferation marker Ki-67 in early breat cancer.J Clin Oncol 2005;23:7212-20.
18.Li ZM,Huang JJ,Xia Y,et al.High Ki-67 expression in diffuse large B-cell lymphoma patients with nongerminal center subtype indicates limited survival benefit from R-CHOP therapy.Eur J Haematol2012;88:510-7.
19.Abrey LE,Batchelor TT,Ferreri AJ,et al.Report of an international workshop to standardize baseline evaluation and response criteria for primary CNSlymphoma.J Clin Oncol 2005;23:5034-43.
20.AI-Abbadi MA,Hattab EM,Tarawneh MS,et al.Primary testicular diffuse large B-cell lymphoma belongs to the nongerminal center B-cell-like subgroup:A study of 18 cases.Mod Pathol 2006;19:1521-7.
21.Krol AD,le Cessie S,Snijder S,et al.Primary extranodal non-Hodgkin’s lymphoma(NHL):the impact of alternative definitions tested in the Comprehensive Cancer Centre West population-based NHL registry.Ann Oncol 2003;14:131-9.
22.Warrick J,Luo J,Robirds D,et al.Gastrointestinal lymphomas in a North American population:clinicopathologic features from one major CentralMidwestern United States tertiary care medical center.Diagn Pathol 2012;7:76.
23.Govi S,Patti C,Raderer M,et al.Final results of a multicenter phase II trial assessing the activity and efficacy of Helicobacter pylori-eradicating antibiotic therapy as exclusive treatment for patients with stage I-III diffuse large B-cell lymphoma of the stomach(the HGL-1 trial).Blood 2011;118:958.
24.Shankland KR,Armitage JO,Hancock BW.NonHodgkin lymphoma.Lancet 2012;380:848-75.
25.Sant M,Allemani C,De Angelis R,et al.Influence of morphology on survival for non-Hodgkin’s lymphoma in Europe and the United States.Eur JCancer 2008;44:579-87.
26.Warrick J,Luo J,Robirds D,et al.Gastrointestinal lymphomas in a North American population:clinicopathologic features from one major CentralMidwestern United States tertiary care medical center.Diagn Pathol 2012;7:76.
27.Ghimire P,Wu GY,Zhu L.Primary gastrointestinal lymphoma.World J Gastroenterol 2011;17:697-707.
28.Li X,Xia B,Guo S,et al.A retrospective analysis of primary gastric diffuse large B-cell lymphoma with or without concomitant mucosa-associated lymphoid tissue(MALT)lymphoma components.Ann Hematol2013;92:807-15.
29.Wu YX,Liu B,Chen L,et al.Prognostic factors of primary gastric diffuse large B-cell lymphoma:a retrospective study of 75 cases in China.Ann Hematol2013;92:861-2.
30.Kim SJ,Kang HJ,Kim JS,et al.Comparison of treatment strategies for patients with intestinal diffuse large B-cell lymphoma:surgical resection followed by chemotherapy versus chemotherapy alone.Blood2011;117:1958-65.
31.Yamanaka R,Homma J,Sano M,et al.Immunochemotherapy with a combination of rituximab,methotrexate,pirarubicin and procarbazine for patients with primary CNS lymphoma-a preliminary report.Leuk lymphoma 2007;48:1019-22.
2.Armitage JO,Gascoyne RD,Lunning MA,et al.Non-Hodgkin lymphoma.Lancet 2017;390:298-310.
3.Chen W,Sun K,Zheng R,et al.Cancer incidence and mortality in China,2014.Chin J Cancer Res2018;30:1-12.
4.Zucca E,Roggero E,Bertoni F,et al.Primary extranodal non-Hodgkin’s lymphomas.Part 1:Gastrointestinal,cutaneous and genitourinary lymphomas.Ann Oncol 1997;8:727-37.
5.Zucca E,Roggero E,Bertoni F,et al.Primary extranodal non-Hodgkin’s lymphomas.Part 2:Head and neck,central nervous system and other less common sites.Ann Oncol 1999;10:1023-33.
6.Swerdlow SH,Campo E,Harris NL,et al.WHOClassification of Tumors of Haematopoietic and Lymphoid Tissues(4th edition).Lyon:IARC Press,2008.
7.Rosenwald A,Wright G,Chan WC,et al.The use of molecular profiling to predict survival after chemotherapy for diffuse large-B-cell lymphoma.NEngl J Med 2002;346:1937-47.
8.Aoki R,Karube K,Sugita Y,et al.Distribution of malignant lymphoma in Japan:analysis of 2260 cases,2001-2006.Pathol Int 2008;58:174-82.
9.Yang QP,Zhang WY,Yu JB,et al.Subtype distribution of lymphoma in Southwest China:analysis of 6,382 cases using WHO classification in a single institution.Diagn Pathol 2011;6:77.
10.Schmitz R,Wright GW,Huang DW,et al.Genetics and pathogenesis of diffuse large b-cell lymphoma.N Engl J Med 2018;378:1396-407.
11.Edge SB,Byrd DR,Compton CC,et al.AJCCCancer Staging Manual.7th Edition.New York:Springer,2010.
12.Hans CP,Weisenburger DD,Greiner TC,et al.Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry of diffuse using a tissue microarray.Blood 2004;103:275-82.
13.International Non-Hodgkin’s Lymphoma Prognostic Factors Project.A predictive model for aggressive non-Hodgkin’s lymphoma.N Engl J Med 1993;329:987-94.
14.Sun J,Yang Q,Lu Z,et al.Distribution of lymphoid neoplasms in China:analysis of 4,638 cases according to the World Health Organization classification.Am JClin Pathol 2012;138:429-34.
15.Swerdlow SH,Campo E,Pileri SA,et al.The 2016revision of the World Health Organization classification of lymphoid neoplasms.Blood 2016;127:2375-90.
16.Yao S,Li J,Yao Z,et al.Extranodal involvement in young patients with diffuse large B-cell lymphoma:distribution,prognostic value and treatment options.Chin J Cancer Res 2017;29:57-65.
17.Urruticoechea A,Smith IE,Dowsett M.Proliferation marker Ki-67 in early breat cancer.J Clin Oncol 2005;23:7212-20.
18.Li ZM,Huang JJ,Xia Y,et al.High Ki-67 expression in diffuse large B-cell lymphoma patients with nongerminal center subtype indicates limited survival benefit from R-CHOP therapy.Eur J Haematol2012;88:510-7.
19.Abrey LE,Batchelor TT,Ferreri AJ,et al.Report of an international workshop to standardize baseline evaluation and response criteria for primary CNSlymphoma.J Clin Oncol 2005;23:5034-43.
20.AI-Abbadi MA,Hattab EM,Tarawneh MS,et al.Primary testicular diffuse large B-cell lymphoma belongs to the nongerminal center B-cell-like subgroup:A study of 18 cases.Mod Pathol 2006;19:1521-7.
21.Krol AD,le Cessie S,Snijder S,et al.Primary extranodal non-Hodgkin’s lymphoma(NHL):the impact of alternative definitions tested in the Comprehensive Cancer Centre West population-based NHL registry.Ann Oncol 2003;14:131-9.
22.Warrick J,Luo J,Robirds D,et al.Gastrointestinal lymphomas in a North American population:clinicopathologic features from one major CentralMidwestern United States tertiary care medical center.Diagn Pathol 2012;7:76.
23.Govi S,Patti C,Raderer M,et al.Final results of a multicenter phase II trial assessing the activity and efficacy of Helicobacter pylori-eradicating antibiotic therapy as exclusive treatment for patients with stage I-III diffuse large B-cell lymphoma of the stomach(the HGL-1 trial).Blood 2011;118:958.
24.Shankland KR,Armitage JO,Hancock BW.NonHodgkin lymphoma.Lancet 2012;380:848-75.
25.Sant M,Allemani C,De Angelis R,et al.Influence of morphology on survival for non-Hodgkin’s lymphoma in Europe and the United States.Eur JCancer 2008;44:579-87.
26.Warrick J,Luo J,Robirds D,et al.Gastrointestinal lymphomas in a North American population:clinicopathologic features from one major CentralMidwestern United States tertiary care medical center.Diagn Pathol 2012;7:76.
27.Ghimire P,Wu GY,Zhu L.Primary gastrointestinal lymphoma.World J Gastroenterol 2011;17:697-707.
28.Li X,Xia B,Guo S,et al.A retrospective analysis of primary gastric diffuse large B-cell lymphoma with or without concomitant mucosa-associated lymphoid tissue(MALT)lymphoma components.Ann Hematol2013;92:807-15.
29.Wu YX,Liu B,Chen L,et al.Prognostic factors of primary gastric diffuse large B-cell lymphoma:a retrospective study of 75 cases in China.Ann Hematol2013;92:861-2.
30.Kim SJ,Kang HJ,Kim JS,et al.Comparison of treatment strategies for patients with intestinal diffuse large B-cell lymphoma:surgical resection followed by chemotherapy versus chemotherapy alone.Blood2011;117:1958-65.
31.Yamanaka R,Homma J,Sano M,et al.Immunochemotherapy with a combination of rituximab,methotrexate,pirarubicin and procarbazine for patients with primary CNS lymphoma-a preliminary report.Leuk lymphoma 2007;48:1019-22.