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

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 patents were 62.5％ and 54.2％.The 5-year OS rate for patents with N-DLBCL and EN-DLBCL were 65.5％ and 56.9％ (P=0.008),and the 5-year PFS were 57.0％ 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.