Analysis of histopathological and clinical prognostic factors in lymphomas involving the gastrointestinal system

Abstract

BACKGROUND

Primary gastrointestinal lymphomas (PGIL) are rare tumors that can involve the whole gastrointestinal (GI) tract. Although lymphomas can originate from any part of the gastrointestinal tract, the most common sites are the stomach, small intestine, and ileocecal region.

AIM

To examine the clinicopathologic and prognostic features of PGIL.

METHODS

We performed a retrospective single-center analysis of 111 patients diagnosed with gastrointestinal lymphomas (GIL) at Izmir Katip Celebi University Ataturk Training and Research Hospital. Histopathological, clinical, and prognostic parameters, including pathological subtype, Helicobacter pylori infection, tumor stage, grade, Performance Score (PS), International Prognostic Index, lactate dehydrogenase (LDH) level, and treatment modality of PGILs (2006-2018), were retrospectively analyzed using SPSS 25.0.

RESULTS

The study included 111 patients diagnosed with GIL. The median age was 66 years (60 males, 51 females). Sites of involvement were stomach (67.5%), small bowel (18%), large bowel/rectum (12.6%), and pancreas (1.8%). Among 62 patients with primary GIL, 49 (79%) had diffuse large B-cell lymphoma (DLBCL), 6 (9.7%) had extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue, 2 (3.2%) had mantle cell lymphoma, 2 (3.2%) had unclassified B-cell lymphoma, and 2 (3.2%) had T-cell lymphoma. The 1-, 3-, and 5-year overall survival (OS) and event-free survival rates were 67%, 56%, 47%, and 80%, 58.6%, 54.4%, respectively. In univariate analysis, LDH level (LDH ≥ 270 U/L) (P = 0.029), PS [Eastern Cooperative Oncology Group (ECOG) ≥ 2] (P < 0.0001), and surgical treatment (P = 0.002) were associated with survival. In multivariate analysis, a poor PS (ECOG ≥ 2) (P = 0.010) was an independent predictor of poor OS.

CONCLUSION

In this study, the stomach was the most frequently involved site, DLBCL was the predominant subtype, and poor performance status was associated with poorer survival.

Keywords: Gastrointestinal system; Lymphoma; Gastric lymphoma; Intestinal lymphoma

Core Tip: Primary gastrointestinal lymphoma (PGIL) is a rare and heterogeneous disease with diverse clinicopathologic and prognostic features. In this retrospective study of 62 primary cases, the stomach was the most frequently involved site, and diffuse large B-cell lymphoma was the predominant subtype. Poor performance status emerged as an independent predictor of reduced overall survival. This finding contributes to a better understanding of prognostic determinants in PGIL and may guide individualized management strategies in clinical practice.