Multicenter retrospective analysis of 581 patients with primary intestinal non-hodgkin lymphoma from the Consortium for Improving Survival of Lymphoma (CISL)

Abstract

Background: Primary intestinal non-Hodgkin lymphoma (NHL) is a heterogeneous disease with regard to anatomic and histologic distribution. Thus, analyses focusing on primary intestinal NHL with large number of patients are warranted.

Methods: We retrospectively analyzed 581 patients from 16 hospitals in Korea for primary intestinal NHL in this retrospective analysis. We compared clinical features and treatment outcomes according to the anatomic site of involvement and histologic subtypes.

Results: B-cell lymphoma (n = 504, 86.7%) was more frequent than T-cell lymphoma (n = 77, 13.3%). Diffuse large B-cell lymphoma (DLBCL) was the most common subtype (n = 386, 66.4%), and extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) was the second most common subtype (n = 61, 10.5%). B-cell lymphoma mainly presented as localized disease (Lugano stage I/II) while T-cell lymphomas involved multiple intestinal sites. Thus, T-cell lymphoma had more unfavourable characteristics such as advanced stage at diagnosis, and the 5-year overall survival (OS) rate was significantly lower than B-cell lymphoma (28% versus 71%, P < 0.001). B symptoms were relatively uncommon (20.7%), and bone marrow invasion was a rare event (7.4%). The ileocecal region was the most commonly involved site (39.8%), followed by the small (27.9%) and large intestines (21.5%). Patients underwent surgery showed better OS than patients did not (5-year OS rate 77% versus 57%, P < 0.001). However, this beneficial effect of surgery was only statistically significant in patients with B-cell lymphomas (P < 0.001) not in T-cell lymphomas (P = 0.460). The comparison of survival based on the anatomic site of involvement showed that ileocecal regions had a better 5-year overall survival rate (72%) than other sites in consistent with that ileocecal region had higher proportion of patients with DLBCL who underwent surgery. Age > 60 years, performance status ≥ 2, elevated serum lactate dehydrogenase, Lugano stage IV, presence of B symptoms, and T-cell phenotype were independent prognostic factors for survival.

Conclusions: The survival of patients with ileocecal region involvement was better than that of patients with involvement at other sites, which might be related to histologic distribution, the proportion of tumor stage, and need for surgical resection.

Figure 1

Comparison of survival curves based on the site of involvement. (A, B) Overall and progression-free survival curves according to primary site of involvement. Patients with ileocecal region involvement had better survival outcomes than patients with involvement of the small and large intestines. The outcomes of patients with multiple intestinal involvement were significantly worse (P < 0.01).

Figure 2

Comparison of survival curves based on the histologic subtypes. (A, B) Overall and progression-free survival curves according to subtype of B-cell lymphoma. MALT lymphoma showed better OS than other subtypes, while BL and DLBCL showed similar OS curves to each other. (C, D) Overall and progression-free survival curves according to subtype of T-cell lymphoma. There were no significant differences among PTCL-U, EATL, and ENKTL.

Figure 3

Comparison of survival curves based on the clinical characteristics. (A) Lugano stage II2 and IV cases had significantly worse OS, while there were no significant differences in OS between stage I and II1. (B) IPI was significantly associated with OS. (C) In B-cell lymphoma, patients who underwent surgical resectioning had better OS than patients that did not. (D) Surgical resections failed to lead to survival differences in T-cell lymphoma.