Anatomical laterality of primary intestinal diffuse large B-cell lymphoma independently stratifies survival: New prognostic nomogram incorporating tumor location

doi:10.3748/wjg.v32.i7.115406

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 32, Issue 7

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Supplementary Materials of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (19)

All Articles published online

The chart showing PDF series, HTML series, Figures (1-7) series, Tables (1-2) series.

Item

Count

PDF

HTML

Figures (1-7)

Tables (1-2)

Sum=28

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

Download

Sum=1

Feb 21, 2026 (publication date) through Feb 6, 2026

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Gastroenterology

ISSN

1007-9327

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Feb 21, 2026; 32(7): 115406
Published online Feb 21, 2026. doi: 10.3748/wjg.v32.i7.115406

Anatomical laterality of primary intestinal diffuse large B-cell lymphoma independently stratifies survival: New prognostic nomogram incorporating tumor location

Rui-Xin Zeng, Cai-Qin Wang, Hang Yang, Peng Sun, Pan-Pan Liu, Lin-Chuan Wei, Ting-Ting Chen, Zhao Wang, He Huang, Zhi-Ming Li, Xiao-Peng Tian, Yu Wang

Rui-Xin Zeng, Hang Yang, Peng Sun, Pan-Pan Liu, Zhao Wang, He Huang, Zhi-Ming Li, Xiao-Peng Tian, Yu Wang, Department of Medical Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China

Cai-Qin Wang, Department of Lymphoma and Hematology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Hunan Cancer Hospital, Changsha 410013, Hunan Province, China

Lin-Chuan Wei, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China

Ting-Ting Chen, Department of Hematology, Shenzhen Hospital of Southern Medical University, Shenzhen 518100, Guangdong Province, China

Co-first authors: Rui-Xin Zeng and Cai-Qin Wang.

Co-corresponding authors: Xiao-Peng Tian and Yu Wang.

Author contributions: Zeng RX and Wang CQ contributed equally to this work; Zeng RX performed the statistical analyses, prepared the figures and tables, and drafted the manuscript; Wang CQ obtained institutional review board approval for the study, coordinated data collection, and critically revised the manuscript for important intellectual content; Wei LC was responsible for case identification, data extraction; Yang H, Sun P, Liu PP, Chen TT, Wang Z, and Huang H contributed to data acquisition and curation, and assisted in data interpretation and manuscript revision; Li ZM, Tian XP, and Wang Y supervised the study, provided critical revision of the manuscript for important intellectual content, and approved the final version.

Supported by the National Natural Science Foundation of China, No. 82104273, No. 82422010, No. 82370190 and No. 82204414; Guangdong Basic and Applied Basic Research Foundation, No. 2024B1515020026; Hunan Provincial Natural Science Foundation of China, No. 2025JJ60485; and Innovative Tumor Supportive Care Research Project, No. cphcf-2023-157.

Institutional review board statement: The clinical data were acquired with the approval and permission of the Institutional Review Board of the Sun Yat-sen University Cancer Center. The study protocol was approved by the ethical committee of Sun Yat-sen University Cancer Center (approval No. B2024-241-01) and the study was performed under the principles of the Declaration of Helsinki.

Informed consent statement: Informed consent was not required because this study was a retrospective report of cases, which is a retrospective analysis of clinical data with no relevance to human biological ethic problems. The need for informed consent was waived by the ethical committee of the Sun Yat-sen University Cancer Center. All methods were performed following the relevant guidelines and regulations.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Data sharing statement: The SEER data and software used in this manuscript are publicly available at the following website: https://seer.cancer.gov/data-software/documentation/seerstat/.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Yu Wang, MD, Doctor, Department of Medical Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Yuexiu District, Guangzhou 510060, Guangdong Province, China. wangyu@sysucc.org.cn

Received: October 21, 2025
Revised: December 2, 2025
Accepted: December 26, 2025
Published online: February 21, 2026
Processing time: 109 Days and 5.9 Hours

Abstract

BACKGROUND

Primary intestinal (PI) diffuse large B-cell lymphoma (DLBCL) represents a biologically and clinically heterogeneous subtype of extranodal lymphoma. The international prognostic index (IPI) was originally developed for predominantly nodal DLBCL (N-DLBCL) and inadequately reflected site-specific risk within the intestine. Prompted by colorectal carcinoma where primary tumor laterality (left vs right of the splenic flexure) is prognostically relevant, we raised the question of whether analogous intestinal laterality might influence survival in PI-DLBCL.

AIM

To investigate whether intestinal laterality influences survival in PI-DLBCL and construct a location-integrated prognostic nomogram.

METHODS

We retrospectively analyzed 3832 PI-DLBCL patients (SEER 2002-2021) and externally validated in 107 patients (Sun Yat-sen University Cancer Center 2014-2024). A prognostic nomogram integrating age, Ann Arbor stage, chemotherapy, surgery, and tumor sidedness (left vs right of the splenic flexure) was constructed. To mitigate treatment-selection bias, we additionally performed propensity score matching (PSM) for left- vs right-sided PI-DLBCL.

RESULTS

Left-sided PI-DLBCL was independently associated with inferior overall survival (OS) (hazard ratio = 1.15, P = 0.035) and the association persisted after PSM. When compared with intra-abdominal N-DLBCL, right-sided PI-DLBCL showed superior OS, whereas left-sided PI-DLBCL had worse OS. The nomogram achieved superior discrimination vs the IPI (C-index: 0.749 vs 0.710) and higher time-dependent area under the curves (1-year: 0.865 vs 0.753; 2-year: 0.792 vs 0.731; 3-year: 0.786 vs 0.727) in the external validation cohort. The nomogram stratified patients into low-, median-, and high-risk groups with clear OS separation in both the training and external cohorts.

CONCLUSION

Intestinal laterality is an independent, clinically actionable determinant of survival in PI-DLBCL. The proposed nomogram provides individualized survival prediction and risk stratification and showed higher discrimination than the IPI, supporting the incorporation of tumor anatomical location into prognostic assessment and risk-adapted management.

Keywords: Primary intestinal diffuse large B-cell lymphoma; Prognostic model; SEER; External validation; Risk factors

Core Tip: This study identifies intestinal laterality (left vs right of the splenic flexure) as a key, previously overlooked prognostic factor in primary intestinal diffuse large B-cell lymphoma (DLBCL): Left-sided disease confers worse overall survival, whereas right-sided disease even surpasses intra-abdominal nodal DLBCL. Leveraging SEER (n = 3832) and an external validation cohort (n = 107), we built and validated a simple nomogram (age, stage, chemotherapy, surgery, laterality) that delivered higher discrimination than the international prognostic index. The model operationalizes tumor location for individualized prognosis and may inform risk-adapted clinical decisions.