J Korean Med Sci.  2014 Jan;29(1):53-60. 10.3346/jkms.2014.29.1.53.

Intestinal Diffuse Large B-Cell Lymphoma: An Evaluation of Different Staging Systems

• Hwang HS
• Yoon DH
• Suh C
• Park CS
• Huh J

• KMID: 1796915
• DOI: http://doi.org/10.3346/jkms.2014.29.1.53

Abstract

The gastrointestinal tract is the most common primary extranodal site for diffuse large B-cell lymphoma (DLBCL). However, there is no consensus on the most appropriate staging system for intestinal DLBCL. We evaluated the utility of the modified Ann Arbor system, the Lugano system, and the Paris staging system (a modification of the Tumor, Node, Metastases [TNM] staging for epithelial tumors) in 66 cases of resected intestinal DLBCL. The cases were treated with surgery, plus either cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) chemotherapy alone (n=26) or with the addition of rituximab immunotherapy (n=40). Median follow-up time was 40.4 months (range, 2.1-171.6 months). Fifty-six patients (84.8%) achieved complete remission. The overall 5-yr survival rate was 86.4% (57/66). Of the stage categories defined for each staging system, only the T stage of the Paris classification showed prognostic significance for overall survival by univariate analysis. However, none of the stage parameters was significantly correlated with patient survival on multivariate analysis. In conclusion, the results suggest that the T stage of the Paris classification system may be a prognostic indicator in intestinal DLBCL. The results also imply that in surgically resected intestinal DLBCL, the addition of rituximab to the CHOP regimen does not confer significant survival advantage.

Keyword

Lymphoma, Large B-Cell, Diffuse; Intestines; Stage; Rituximab

MeSH Terms

Adolescent
Adult
Aged
Antibodies, Monoclonal, Murine-Derived/therapeutic use
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
Cyclophosphamide/therapeutic use
Doxorubicin/therapeutic use
Female
Humans
Immunologic Factors/therapeutic use
Intestinal Neoplasms/*classification/drug therapy/mortality/surgery
Lymphoma, Large B-Cell, Diffuse/*classification/drug therapy/mortality/surgery
Male
Middle Aged
Neoplasm Staging/*methods
Prednisone/therapeutic use
Retrospective Studies
Survival
Survival Rate
Treatment Outcome
Vincristine/therapeutic use
Young Adult
Antibodies, Monoclonal, Murine-Derived
Immunologic Factors
Vincristine
Doxorubicin
Cyclophosphamide
Prednisone

Figure

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  Fig. 1 Pathologic evaluation of depth of invasion and stage. Representative intestinal DLBCL cases involving mucosa and superficial submucosa (A, H&E, ×40), muscularis propria (B, H&E, scan view), subserosa (C, H&E, scan view), serosa (black arrows) (D, H&E, scan view), regional lymph node metastasis (E, H&E, ×40), and appendix non-contiguously (empty arrows) (F-H). (F) low magnification (H&E, ×40); (G) high magnification of region of interest in F (H&E, ×200); (H) CD20 immunostaining to identify the lesion (×200).

• 

  Fig. 2 Kaplan-Meier survival curves of overall survival according to clinical variables: (A) IPI risk group and (B) ECOG performance score.

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  Fig. 3 Kaplan-Meier survival curves of overall survival according to (A) T stage, (B) N stage, (C) M stage of the Paris classification system, and (D) modified Paris T stage. Note that the survival curves of the mucosa (M)/submucosa (SM) invasion group and the muscularis propria (PM) invasion group overlap completely. Abbreviations: M, mucosal confinement; PM, muscularis propria invasion; SM, submucosal invasion; SS, subserosal invasion; SI, serosa/adjacent organ invasion and/or perforation.

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