Ma JJ, Zhang H, Wang CC, Ji WL, Zhao Y, Li XX. Clinical characteristics and prognostic analysis of three hundred and nineteen cases of primary gastrointestinal diffuse large B-cell lymphoma. World J Gastrointest Oncol 2025; 17(12): 113661 [DOI: 10.4251/wjgo.v17.i12.113661]
Corresponding Author of This Article
Xin-Xia Li, PhD, Chief Physician, Professor, Pathology Center, Xinjiang Medical University Affiliated Tumor Hospital, No. 789 Suzhou East Street, Xinshi District, Urumqi 830000, Xinjiang Uygur Autonomous Region, China. lxxpatho@163.com
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Oncology
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Dec 15, 2025 (publication date) through Dec 14, 2025
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World Journal of Gastrointestinal Oncology
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1948-5204
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Ma JJ, Zhang H, Wang CC, Ji WL, Zhao Y, Li XX. Clinical characteristics and prognostic analysis of three hundred and nineteen cases of primary gastrointestinal diffuse large B-cell lymphoma. World J Gastrointest Oncol 2025; 17(12): 113661 [DOI: 10.4251/wjgo.v17.i12.113661]
World J Gastrointest Oncol. Dec 15, 2025; 17(12): 113661 Published online Dec 15, 2025. doi: 10.4251/wjgo.v17.i12.113661
Clinical characteristics and prognostic analysis of three hundred and nineteen cases of primary gastrointestinal diffuse large B-cell lymphoma
Jia-Jia Ma, Huan Zhang, Cui-Cui Wang, Wen-Li Ji, Ying Zhao, Xin-Xia Li
Jia-Jia Ma, Huan Zhang, Cui-Cui Wang, Wen-Li Ji, Xin-Xia Li, Pathology Center, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
Ying Zhao, Department of General Practice, The Third People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
Author contributions: Ma JJ contributed to conception and design of the research, applied funding, and drafted the manuscript; Zhang H conducted experiments; Wang CC performed statistical analysis; Li XX, Ji WL, and Li XX revised the manuscript for important intellectual content; Ma JJ and Zhao Y conducted analysis and interpretation of data; and all authors have read and approved the final manuscript.
Supported by the Natural Science Foundation of Xinjiang Uygur Autonomous Region, No. 2022D01D21; “Tianshan Talents” Cultivation Program of Xinjiang Uygur Autonomous Region, No. 2024TSYCLJ0025; and National Natural Science Foundation of China, No. 82360037.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Xinjiang Medical University Affiliated Tumor Hospital, approval No. K-2025079.
Informed consent statement: Informed consent was waived due to the study's retrospective nature, and all patient data were anonymized to maintain confidentiality throughout the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available due to patient privacy regulations but may be obtained from the corresponding authors upon reasonable request.
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: Xin-Xia Li, PhD, Chief Physician, Professor, Pathology Center, Xinjiang Medical University Affiliated Tumor Hospital, No. 789 Suzhou East Street, Xinshi District, Urumqi 830000, Xinjiang Uygur Autonomous Region, China. lxxpatho@163.com
Received: September 1, 2025 Revised: September 18, 2025 Accepted: November 5, 2025 Published online: December 15, 2025 Processing time: 102 Days and 17 Hours
Abstract
BACKGROUND
Primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL), the most prevalent extranodal non-Hodgkin lymphoma, poses significant diagnostic and therapeutic challenges due to its non-specific symptoms and poor prognosis.
AIM
To develop and validate a risk model for the early identification of PGI-DLBCL using Least Absolute Shrinkage and Selection-Cox regression, with the aim of guiding clinical decision-making.
METHODS
The clinical data of patients diagnosed with PGI-DLBCL at the Tumor Hospital Affiliated to Xinjiang Medical University were analyzed retrospectively from January 2010 to April 2022.
RESULTS
A total of 319 patients with PGI-DLBCL were included and divided into training (n = 223) and validation (n = 96) cohorts. The median age was 55 years, with 48.9% male and 51.1% female patients. Key clinical features included Eastern Cooperative Oncology Group performance status ≥ 2 (40.8%), advanced-stage disease (stage IV: 27.6%), extranodal involvement ≥ 2 sites (47%), tumor > 5 cm (46.1%), elevated beta-2 microglobulin (50.5%), elevated lactate dehydrogenase (27%), high International Prognostic Index (3-5: 69.9%), non-germinal center B-cell-like subtype (59.9%), and B symptoms (55.8%). Immunohistochemical analysis showed frequent expression of CD10 (51.1%), B-cell lymphoma 6 (53.3%), multiple myeloma oncogene 1 (40.1%), B-cell lymphoma 2 (49.2%), myelocytomatosis viral oncogene homolog (48.3%), Ki-67 (67.1%), and CD5 (42.6%); Epstein-Barr virus-encoded RNA was positive in 3.1%. Based on Least Absolute Shrinkage and Selection regression and subsequent univariate and multivariate Cox regression analyses, extranodal sites ≥ 2, B symptoms, mixed lesion type, and negative multiple myeloma oncogene 1 expression were identified as independent risk factors for PGI-DLBCL. The risk model stratified patients into high- and low-risk groups with significantly different overall survival (P < 0.05). Area under the curve values for 1-, 3-, and 5-year overall survival were 0.625, 0.663, and 0.723 in the training cohort, with consistent performance in the validation cohort. Decision curve analysis indicated favorable clinical utility.
CONCLUSION
PGI-DLBCL in our cohort showed distinctive clinical features and a predominance of the non-germinal center B-cell-like subtype. Decision curve analysis confirmed the clinical applicability of our prognostic model. Although molecular biomarkers will be needed to improve predictive precision, our model offers a practical tool for early risk identification and individualized management in clinical practice.
Core Tip: Primary gastrointestinal diffuse large B-cell lymphoma predominantly affects elderly men over 60 years, with abdominal pain, distension, and significant weight loss as common initial symptoms. Lesions are primarily located in the gastric body, antrum, and colon, often presenting as ulcerative or raised masses on endoscopy. Key independent prognostic risk factors include age > 60 years, presence of B symptoms, and elevated serum lactate dehydrogenase > 250 U/L, which correlate with poor survival outcomes and necessitate early diagnosis and targeted therapy.
