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Treatment of gastrointestinal diffuse large B cell lymphoma in China: a 10-year retrospective study of 114 cases

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Abstract

Gastrointestinal diffuse large B cell lymphoma (DLBCL) is a common subtype of extranodal lymphoma. There has been uncertainty about the clinical efficacy of combination therapy (surgery and chemotherapy) for gastrointestinal DLBCL. We retrospectively analyzed 114 patients with newly diagnosed gastrointestinal DLBCL from six medical centers. We evaluated four groups based on whether they were treated with or without surgery as the initial treatment for DLBCL, followed by either a regimen with cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) or CHOP with rituximab (R-CHOP). For all patients, treatment with R-CHOP resulted in significantly greater overall survival (OS; 93.2 vs 74.5 %, p = 0.008) and progression-free survival (89.8 % vs 72.7, p = 0.029). Tumor resection did not improve OS (84.0 vs 85.0 %, for surgery and chemotherapy alone, respectively, p = 0.980). However, for younger patients, overall survival was greater (p = 0.005) for patients treated with surgery plus chemotherapy (83.9 %) than for patients treated with chemotherapy alone (40.0 %). Elevated serum lactate dehydrogenase level (p = 0.004) and performance status (Eastern Cooperative Oncology Group; p = 0.003) were independent predictors of survival in patients with gastrointestinal DLBCL. Stage-modified IPI was recognized as the best prognostic tool. There were significant differences among patients with low-risk, intermediate-risk, and high-risk groups in 50-month OS (94.2 vs 84.0 vs 66.7 %, p = 0.008). The results of this large-scale study suggest that R-CHOP regimen is the first-line treatment for gastrointestinal DLBCL. The benefit of surgery for these patients remains controversial. Further prospective analyses are warranted.

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Acknowledgments

We are indebted to Dr. Chenli Zhang and Dr. Jing Sun, Department of Gastroenterology, Shanghai Ruijin Hospital for their contribution to the collection of patient data. We would like to thank the doctors from Shanghai Lymphoma Research Group for their contribution to this study. We thank all the pathologists, oncologists, radiologists, surgeons, and nurses who contributed.

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The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Hematology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin No.2 Road, Shanghai, 200025, People’s Republic of China

    Xiaoyang Li, Weina Shen, Junmin Li & Zhixiang Shen

  2. Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China

    Junning Cao

  3. Changhai Hospital, Shanghai, China

    Jianmin Wang

  4. Renji Hospital, Shanghai, China

    Fangyuan Chen

  5. Shanghai No.1 People’s Hospital, Shanghai, China

    Chun Wang

  6. Zhongshan Hospital, Shanghai, China

    Shanhua Zou

  7. Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Boyong Shen

  8. Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Ren Zhao

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  1. Xiaoyang Li
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  2. Weina Shen
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  9. Ren Zhao
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  10. Junmin Li
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  11. Zhixiang Shen
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Correspondence to Junmin Li.

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Xiaoyang Li and Weina Shen contributed equally to this work.

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Li, X., Shen, W., Cao, J. et al. Treatment of gastrointestinal diffuse large B cell lymphoma in China: a 10-year retrospective study of 114 cases. Ann Hematol 91, 1721–1729 (2012). https://doi.org/10.1007/s00277-012-1507-1

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  • DOI: https://doi.org/10.1007/s00277-012-1507-1

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