Patterns of outcome and prognostic factors in primary large-cell lymphoma of the testis in a survey by the International Extranodal Lymphoma Study Group.
OBJECTIVE
To determine clinical features and patterns of outcome of primary testicular diffuse large B-cell lymphomas (DLCL).


METHODS
A retrospective international survey of 373 patients with primary testicular DLCL.


RESULTS
Most patients presented with localized disease (stage I to II), and the median age at diagnosis was 66 years (range, 19 to 91 years). Anthracycline-based chemotherapy was administered to 255 patients (68%), and prophylactic intrathecal chemotherapy was given to 68 patients (18%); 133 patients (36%) received prophylactic scrotal radiotherapy. Median overall survival was 4.8 years, and median progression-free survival was 4 years. The survival curves showed no clear evidence of a substantial proportion of cured patients. A favorable international prognostic index score (IPI), no B-symptoms, the use of anthracyclines, and prophylactic scrotal radiotherapy were significantly associated with longer survival at multivariate analysis. However, even for patients with stage I disease and good-risk IPI, the outcome seems worse than what was reported for DLCL at other sites. At a median follow-up of 7.6 years, 195 patients (52%) had relapsed. Extranodal recurrence was reported in 140 cases. Relapses in CNS were detected in 56 patients (15%) up to 10 years after presentation. A continuous risk of recurrence in the contralateral testis was seen in patients not receiving scrotal radiotherapy.


CONCLUSIONS
Testicular DLCL is characterized by a particularly high risk of extranodal relapse even in cases with localized disease at diagnosis. Anthracycline-based chemotherapy, CNS prophylaxis, and contralateral testicular irradiation seem to improve the outcome. Their efficacy is under evaluation in a prospective clinical trial.
Zucca
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Division of Haematology/Medical Oncology, Peter MacCallum Cancer Institute, East Melbourne, Australia. ielsg@ticino.com
Conconi
A
A
Mughal
T I
TI
Sarris
A H
AH
Seymour
J F
JF
Vitolo
U
U
Klasa
R
R
Ozsahin
M
M
Mead
G M
GM
Gianni
M A
MA
Cortelazzo
S
S
Ferreri
A J M
AJ
Ambrosetti
A
A
Martelli
M
M
Thiéblemont
C
C
Moreno
H Gomez
HG
Pinotti
G
G
Martinelli
G
G
Mozzana
R
R
Grisanti
S
S
Provencio
M
M
Balzarotti
M
M
Laveder
F
F
Oltean
G
G
Callea
V
V
Roy
P
P
Cavalli
F
F
Gospodarowicz
M K
MK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018572:Disease-Free Survival; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome