Zhou SQ, Zhou CQ, Ke QH. Tumor laterality in primary intestinal diffuse large B-cell lymphoma: A prognostic leap or an anatomical mirage? World J Gastroenterol 2026; 32(24): 118538 [DOI: 10.3748/wjg.v32.i24.118538]
Corresponding Author of This Article
Qing-Hua Ke, MD, PhD, Chief Physician, Department of Chemoradiotherapy, Jingzhou No. 1 People’s Hospital and First Affiliated Hospital of Yangtze University, No. 10 Tianhu Road, Shashi District, Jingzhou 434000, Hubei Province, China. 3803354759@qq.com
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Gastroenterology & Hepatology
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review-article
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Zhou SQ, Zhou CQ, Ke QH. Tumor laterality in primary intestinal diffuse large B-cell lymphoma: A prognostic leap or an anatomical mirage? World J Gastroenterol 2026; 32(24): 118538 [DOI: 10.3748/wjg.v32.i24.118538]
World J Gastroenterol. Jun 28, 2026; 32(24): 118538 Published online Jun 28, 2026. doi: 10.3748/wjg.v32.i24.118538
Tumor laterality in primary intestinal diffuse large B-cell lymphoma: A prognostic leap or an anatomical mirage?
Shi-Qiong Zhou, Chao-Qun Zhou, Qing-Hua Ke
Shi-Qiong Zhou, Chao-Qun Zhou, Qing-Hua Ke, Department of Chemoradiotherapy, Jingzhou No. 1 People’s Hospital and First Affiliated Hospital of Yangtze University, Jingzhou 434000, Hubei Province, China
Co-first authors: Shi-Qiong Zhou and Chao-Qun Zhou.
Author contributions: Zhou SQ and Zhou CQ contributed equally to project administration, formal analysis, and manuscript writing as co-first authors; Ke QH contributed to study conceptualization, methodology design, project supervision, and data validation; all authors have reviewed and approved the final version of the manuscript to be published.
AI contribution statement: Limited auxiliary AI tools were used only for basic grammatical correction and linguistic refinement. No large language models such as ChatGPT, DeepL were applied for full-text writing or content creation. All core academic content was independently written by the authors. Individual AI tools were used merely for minor language polishing and grammatical adjustment to improve readability. No AI-based translation, data analysis or manuscript drafting assistance was involved. The study design, data analysis and results interpretation were independently completed by the research team. No AI tools participated in research planning or conclusion interpretation. All figures, tables and images in this manuscript were created and edited by the authors using original research data. No AI-generated images were included.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Qing-Hua Ke, MD, PhD, Chief Physician, Department of Chemoradiotherapy, Jingzhou No. 1 People’s Hospital and First Affiliated Hospital of Yangtze University, No. 10 Tianhu Road, Shashi District, Jingzhou 434000, Hubei Province, China. 3803354759@qq.com
Received: January 7, 2026 Revised: February 14, 2026 Accepted: March 5, 2026 Published online: June 28, 2026 Processing time: 153 Days and 20.2 Hours
Abstract
Primary intestinal diffuse large B-cell lymphoma (PI-DLBCL) is a heterogeneous entity for which the International Prognostic Index offers suboptimal risk stratification. Drawing from the prognostic significance of tumor sidedness in colorectal cancer, recent research has explored whether anatomical laterality influences survival in PI-DBLCL. Previous research has identified left-sided PI-DLBCL as an independent poor prognostic factor and developed a superior laterality-integrated nomogram. In this opinion review, we dissect the methodological limitations, including its reliance on registry data lacking critical molecular and treatment variables, and the modest clinical magnitude of the laterality effect. We then delve into the plausible biological mechanisms underpinning this observation, such as embryologic, microbiomic, and immunological gradients along the intestinal axis, which may shape a distinct tumor microenvironment. Finally, we outline a future research agenda. While tumor laterality is a valuable supplementary prognostic indicator, it currently serves more as a “mirage” than a “leap” for guiding treatment. The path forward requires prospective, biologically annotated cohorts integrating spatial biology, multi-omics, and novel technologies like radiomics and spatial transcriptomics to translate this anatomical observation into clinically actionable insights for personalized management of PI-DLBCL.
Core Tip: The observation that left-sided primary intestinal diffuse large B-cell lymphoma (PI-DLBCL) carries a worse prognosis than right-sided disease introduces a novel anatomical paradigm into lymphoma risk stratification. While intriguing, this finding’s clinical utility is currently limited by modest effect sizes and a lack of mechanistic understanding. This opinion review argues that tumor laterality is best viewed not as an immediate treatment-guiding tool, but as a powerful lens through which to explore the spatial biology of PI-DLBCL. Future research must move beyond anatomical correlation to elucidate the underlying microbiomic, immunologic, and molecular drivers, paving the way for truly personalized therapeutic strategies.
