Annals of Hematology

, Volume 91, Issue 11, pp 1721–1729 | Cite as

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

  • Xiaoyang Li
  • Weina Shen
  • Junning Cao
  • Jianmin Wang
  • Fangyuan Chen
  • Chun Wang
  • Shanhua Zou
  • Boyong Shen
  • Ren Zhao
  • Junmin Li
  • Zhixiang Shen
Original Article

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.

Keywords

Gastrointestinal DLBCL Rituximab Surgery resection Predict prognosis factor Overall survival 

Notes

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.

Disclosure statement

The authors declare no conflict of interest.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Xiaoyang Li
    • 1
  • Weina Shen
    • 1
  • Junning Cao
    • 2
  • Jianmin Wang
    • 3
  • Fangyuan Chen
    • 4
  • Chun Wang
    • 5
  • Shanhua Zou
    • 6
  • Boyong Shen
    • 7
  • Ren Zhao
    • 8
  • Junmin Li
    • 1
  • Zhixiang Shen
    • 1
  1. 1.Department of Hematology, Ruijin HospitalShanghai Jiaotong University School of MedicineShanghaiPeople’s Republic of China
  2. 2.Department of Medical OncologyFudan University Shanghai Cancer CenterShanghaiChina
  3. 3.Changhai HospitalShanghaiChina
  4. 4.Renji HospitalShanghaiChina
  5. 5.Shanghai No.1 People’s HospitalShanghaiChina
  6. 6.Zhongshan HospitalShanghaiChina
  7. 7.Institute of Digestive Surgery, Ruijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
  8. 8.Department of General Surgery, Ruijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina

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