Clinicopathological Characteristics, Risk Factors of Perforation and Prognosis of Primary Small Intestinal Lymphoma: Analysis of 90 Cases / 胃肠病学

ABSTRACT

Background: Primary small intestinal lymphoma is an insidious onset gastrointestinal tumor with a high probability of perforation and poor prognosis. Aims: To investigate the clinicopathological characteristics and the factors related to perforation and prognosis in primary small intestinal lymphoma patients. Methods: The clinical data of patients with primary small intestinal lymphoma admitted to the First Affiliated Hospital of Zhengzhou University from January 2014 to January 2022 were collected retrospectively. The clinical features of patients with different pathological types were compared, and factors related to perforation and prognosis were identified by Logistic regression analysis and Cox regression analysis, respectively. Results: Ninety patients with primary small intestinal lymphoma were enrolled, the male to female ratio was 2∶1, and the median age was 52.5 years old. Abdominal pain was the most common symptom complained by patients (74.4%). All patients were diagnosed as non-Hodgkin’s lymphoma pathologically, of which 70 were B-cell lymphoma and 20 were T-cell lymphoma; diffuse large B-cell lymphoma was the most common histological type. Patients with T-cell lymphoma had a higher incidence of gastrointestinal complications than those with B-cell lymphoma (78.6% vs. 48.6%, P=0.001). Perforation was more commonly seen in T-cell lymphoma, and intestinal obstruction was more commonly seen in B-cell lymphoma. Multivariate Logistic analysis demonstrated that multisite involvement, elevation of lactate dehydrogenase (LDH), and T-cell lymphoma were the independent risk factors for perforation, while in univariate Cox regression analysis, decreased albumin, increased LDH, T-cell lymphoma, perforation and surgical treatment without chemotherapy were associated with poor prognosis. Furthermore, multivariate Cox regression analysis suggested that only surgical treatment without chemotherapy was an independent risk factor for death (HR=8.332, 95% CI 1.453-47.772, P= 0.017). Conclusions: T - cell originated primary small intestinal lymphoma and those with increased LDH or involving multisite of gastrointestinal tract has a higher incidence of perforation. Surgical treatment without chemotherapy is strongly correlated with adverse outcomes. A regular chemotherapy after surgical treatment is highly recommended for primary small intestinal lymphoma patients complicated with perforation.