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Open Access Highly Accessed Research article

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

Seok Jin Kim1, Chul Won Choi2, Yeung-Chul Mun3, Sung Yong Oh4, Hye Jin Kang5, Soon Il Lee6, Jong Ho Won7, Min Kyoung Kim8, Jung Hye Kwon9, Jin Seok Kim10, Jae-Yong Kwak11, Jung Mi Kwon12, In Gyu Hwang13, Hyo Jung Kim14, Jae Hoon Lee15, Sukjoong Oh16, Keon Woo Park6, Cheolwon Suh17 and Won Seog Kim1*

Author Affiliations

1 Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

2 Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea

3 Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea

4 Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea

5 Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea

6 Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea

7 Department of Internal Medicine, Soon Chun Hyang University Hospital, Seoul, Korea

8 Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea

9 Department of Hematology-Oncology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

10 Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

11 Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea

12 Department of Internal Medicine, Jeju University College of Medicine, Jeju, Korea

13 Department of Medicine, Chung-Ang University College of Medicine, Seoul, South Korea

14 Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea

15 Division of Hematology/Oncology, Gachon University Gil Hospital, Gachon University of Medcine and Science, Incheon, Korea

16 Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea

17 Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

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BMC Cancer 2011, 11:321  doi:10.1186/1471-2407-11-321

Published: 29 July 2011

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.

Keywords:
intestine; non-Hodgkin lymphoma; prognosis; histopathology