Clinical characteristics and prognostic analysis of three hundred and nineteen cases of primary gastrointestinal diffuse large B-cell lymphoma

Table 1 Clinical characteristics of the primary gastrointestinal diffuse large B-cell lymphoma patients, n (%)

Characteristics	Total population (n = 319)	Training cohort (n = 223)	Validation cohort (n = 96)	P value
Age, years, median (IQR)	55 (36, 69)	53 (36, 68)	59.5 (36.8, 70.2)	0.48
Age > 60 years				0.62
No	166 (52)	114 (51.1)	52 (54.2)
Yes	153 (48)	109 (48.9)	44 (45.8)
Gender				0.62
Male	156 (48.9)	107 (48)	49 (51)
Female	163 (51.1)	116 (52)	47 (49)
ECOG ≥ 2				0.78
No	189 (59.2)	131 (58.7)	58 (60.4)
Yes	130 (40.8)	92 (41.3)	38 (39.6)
Lugano stage				0.79
I	146 (45.8)	104 (46.6)	42 (43.8)
II	85 (26.6)	57 (25.6)	28 (29.2)
IV	88 (27.6)	62 (27.8)	26 (27.1)
Extranodal invasion site ≥ 2				0.60
No	169 (53)	116 (52)	53 (55.2)
Yes	150 (47)	107 (48)	43 (44.8)
Tumor diameter > 5 cm				0.30
No	172 (53.9)	116 (52)	56 (58.3)
Yes	147 (46.1)	107 (48)	40 (41.7)
β2-MG > 2.2 mg/L				0.89
No	158 (49.5)	111 (49.8)	47 (49)
Yes	161 (50.5)	112 (50.2)	49 (51)
LDH > 250 U/L				0.98
No	233 (73)	163 (73.1)	70 (72.9)
Yes	86 (27)	60 (26.9)	26 (27.1)
IPI				0.17
0-2	96 (30.1)	62 (27.8)	34 (35.4)
3-5	223 (69.9)	161 (72.2)	62 (64.6)
Immunophenotyping				0.11
Non-GCB	191 (59.9)	140 (62.8)	51 (53.1)
GCB	128 (40.1)	83 (37.2)	45 (46.9)
B symptoms				0.38
No	141 (44.2)	95 (42.6)	46 (47.9)
Yes	178 (55.8)	128 (57.4)	50 (52.1)
Primary symptom				0.38
Abdominal pain	73 (22.9)	46 (14.4)	27 (8.5)
Abdominal distension	56 (17.6)	36 (11.3)	20 (6.3)
Abdominal discomfort	49 (15.4)	37 (11.6)	12 (3.8)
Nausea and vomiting	23 (7.2)	19 (6)	4 (1.3)
Anorexia and weight loss	35 (11)	28 (8.8)	7 (2.2)
Altered bowel habits	22 (6.9)	15 (4.7)	7 (2.2)
Melena	21 (6.6)	13 (4.1)	8 (2.5)
Space occupying lesion in the gastrointestinal tract	40 (12.5)	29 (9.1)	11 (3.4)
Lesion type				0.24
Ulceration	101 (31.7)	65 (29.1)	36 (37.5)
Raised	92 (28.8)	62 (27.8)	30 (31.2)
Diffuse	73 (22.9)	55 (24.7)	18 (18.8)
Mixed	53 (16.6)	41 (18.4)	12 (12.5)
Lesion site				0.87
Gastric fundus	15 (4.7)	12 (3.8)	3 (0.9)
Gastric body	83 (26)	58 (18.2)	25 (7.8)
Angular cisature	68 (21.3)	49 (15.4)	19 (6)
Gastric antrum	59 (18.5)	38 (11.9)	21 (6.6)
Intestinal duodenum	21 (6.6)	16 (5)	5 (1.6)
Jejunum	8 (2.5)	6 (1.9)	2 (0.6)
Ileum	9 (2.8)	6 (1.9)	3 (0.9)
Ileocecum	15 (4.7)	12 (3.8)	3 (0.9)
Colon	41 (12.9)	26 (8.2)	15 (4.7)
Treatment-modalities				0.37
Untreated	69 (21.6)	49 (22)	20 (20.8)
Chemotherapy	110 (34.5)	71 (31.8)	39 (40.6)
Surgery	34 (10.7)	27 (12.1)	7 (7.3)
Chemotherapy + surgery	106 (33.2)	76 (34.1)	30 (31.2)
Tissue origin				0.98
Endoscopic biopsies	262 (82.1)	183 (82.1)	79 (82.3)
Surgical tissue	51 (16)	36 (16.1)	15 (15.6)
Abdominal mass puncture tissue	6 (1.9)	4 (1.8)	2 (2.1)
CD10				0.14
Negative	156 (48.9)	103 (46.2)	53 (55.2)
Positive	163 (51.1)	120 (53.8)	43 (44.8)
BCL-6				0.13
Negative	149 (46.7)	98 (43.9)	51 (53.1)
Positive	170 (53.3)	125 (56.1)	45 (46.9)
MUM-1				0.90
Negative	191 (59.9)	133 (59.6)	58 (60.4)
Positive	128 (40.1)	90 (40.4)	38 (39.6)
BCL-2				0.36
Negative	162 (50.8)	117 (52.5)	45 (46.9)
Positive	157 (49.2)	106 (47.5)	51 (53.1)
C-MYC				0.52
Negative	165 (51.7)	118 (52.9)	47 (49)
Positive	154 (48.3)	105 (47.1)	49 (51)
CD5				0.47
Negative	183 (57.4)	125 (56.1)	58 (60.4)
Positive	136 (42.6)	98 (43.9)	38 (39.6)
EBER				0.27
Negative	309 (96.9)	218 (97.8)	91 (94.8)
Positive	10 (3.1)	5 (2.2)	5 (5.2)
Ki-67				0.26
Negative	105 (32.9)	71 (31.8)	34 (35.4)
Positive	214 (67.1)	152 (68.2)	62 (64.6)

IQR: Interquartile range; ECOG: Eastern Cooperative Oncology Group; β2-MG: Β2-microglobulin; LDH: Lactate dehydrogenase; IPI: International prognostic index; GCB: Germinal center B-cell; BCL-6: B-cell lymphoma 6; MUM-1: Multiple myeloma oncogene 1; BCL-2: B-cell lymphoma 2; C-MYC: Myelocytomatosis viral oncogene homolog; EBER: Epstein-Barr virus-encoded RNA.

Table 2 Least absolute shrinkage and selection operator coefficient of characteristics

Characteristics	LASSO (minute)
Age > 60 years	0.191848352
Gender	-0.219651952
ECOG ≥2	0.360853083
Extranodal invasion site ≥ 2	-0.123956342
β2-MG > 2.2 mg/L	0.230048478
LDH > 250 U/L	0.161655196
B symptoms	0.283986826
Lesion type	-0.19044022
Tissue origin	0.033236256
BCL-6	-0.15250168
MUM-1	0.295835406
BCL-2	-0.135437307
CD5	0.191848352

LASSO: Least absolute shrinkage and selection operator; ECOG: Eastern Cooperative Oncology Group; β2-MG: β2-microglobulin; LDH: Lactate dehydrogenase; BCL-6: B-cell lymphoma 6; MUM-1: Multiple myeloma oncogene 1; BCL-2: B-cell lymphoma 2.

Table 3 Univariate and multivariate Cox regression analyses of factors associated with overall survival in the training cohort (n = 223)

Characteristic	Category	Univariate analysis		Multivariate analysis
		HR (95%CI)	P value	HR (95%CI)	P value
Age (year)	≤ 60	Reference	-	Reference	-
	> 60	1.49 (1.01-2.21)	0.045	1.34 (0.90-2.02)	0.153
Gender	Male	Reference	-	NA	NA
	Female	1.27 (0.86-1.89)	0.232	NA	NA
ECOG PS ≥ 2	0-1	Reference	-	Reference	-
	≥ 2	1.52 (1.03-2.25)	0.034	1.52 (0.96-2.41)	0.075
Extranodal sites ≥ 2	No	Reference	-	NA	NA
	Yes	1.00 (0.68-1.48)	0.992	NA	NA
β2-MG (mg/L)	≤ 2.2	Reference	-	Reference	-
	> 2.2	1.56 (1.05-2.31)	0.029	1.39 (0.91-2.11)	0.126
LDH (U/L)	≤ 250	Reference	-	Reference	-
	> 250	0.65 (0.44-0.95)	0.028	0.79 (0.52-1.20)	0.266
B symptoms	No	Reference	-	Reference	-
	Yes	1.64 (1.08-2.48)	0.019	1.56 (1.00-2.41)	0.048
Lesion type	Ulcerative	Reference	-	Reference	-
	Mixed	0.23 (0.10-0.53)	< 0.001	0.21 (0.09-0.49)	< 0.001
	Raised	1.09 (0.64-1.87)	0.742	1.14 (0.65-1.98)	0.647
	Diffuse	1.62 (0.99-2.64)	0.053	1.30 (0.77-2.21)	0.331
Tissue origin	Endoscopic (1)	Reference	-	NA	NA
	Abdominal mass (3)	1.27 (0.80-2.01)	0.307	NA	NA
	Surgical (2)	0.81 (0.49-1.34)	0.405	NA	NA
BCL-6	Negative	Reference	-	NA	NA
	Positive	0.72 (0.49-1.07)	0.104	NA	NA
MUM-1	Positive	Reference	-	Reference	-
	Negative	0.68 (0.46-1.02)	0.062	0.63 (0.41-0.97)	0.034
CD5	Negative	Reference	-	NA	NA
	Positive	0.73 (0.49-1.09)	0.122	NA	NA

Statistically significant values (P < 0.05) are highlighted in bold. Not available indicates variables not included in the multivariate Cox regression model. CI: Confidence interval; HR: Hazard ratio; ECOG PS: Eastern Cooperative Oncology Group Performance Status; β2-MG: Β2-microglobulin; LDH: Lactate dehydrogenase; BCL-6: B-cell lymphoma 6; MUM-1: Multiple myeloma oncogene 1; NA: Not available.