title: Clinicopathological features of pyothorax-associated lymphoma; a retrospective survey involving 98 patients.
abstract: To investigate clinicopathological features of pyothorax-associated lymphoma (PAL), we examined medical records of 98 patients (88 males and 10 females) with PAL at a median age of 70 years (range 51-86). Seventy-nine patients had a history of artificial pneumothorax. Median interval between diagnosis and artificial pneumothorax was 43 years (range 19-64). At diagnosis, performance status (PS) was 0-1 (n=56) and 2-4 (n=42). Clinical stages were I (n=42), II (n=26), III (n=8) and IV (n=22). Pathological diagnosis comprised diffuse large-B-cell (n=78) and peripheral T-cell lymphoma (n=1). Seventeen were treated supportively. The other 81 received aggressive treatments; chemotherapy (n=52), radiotherapy (n=7), surgery (n=4) and combination (n=18). Five-year overall survival (OS) was 0.35 (95% confidence interval, 24% to 45%). Causes of deaths were PAL (n=39), respiratory failure (n=13) and others (n=12). Multivariate analysis identified prognostic factors for OS; lactate dehydrogenase levels [hazard ratio (HR)=2.36; P=0.013], sex (female versus male) (HR=0.15; P=0.01), PS (2-4 versus 0-1) (HR=2.20; P=0.02), clinical stages (III/IV versus I/II) (HR=1.95; P=0.037) and chemotherapy (HR=0.31; P=0.01). Most patients with PAL are elderly and have comorbidities, while some of them achieve durable remission with appropriate treatments. These findings prompt us to establish an optimal treatment strategy on the basis of risk stratification of individual patients.
authors.affiliation: Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya.
authors.forename: H
authors.initials: H
authors.lastname: Narimatsu
authors.affiliation: Department of Pathology, Toranomon Hospital, Tokyo.
authors.forename: Y
authors.initials: Y
authors.lastname: Ota
authors.affiliation: Division of Exploratory Research, the Institute of Medical Science, the University of Tokyo, Tokyo. Electronic address: kami-tky@umin.ac.jp.
authors.forename: M
authors.initials: M
authors.lastname: Kami
authors.affiliation: Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo.
authors.forename: K
authors.initials: K
authors.lastname: Takeuchi
authors.affiliation: Division of Molecular Medicine, Aichi Cancer Center, Nagoya.
authors.forename: R
authors.initials: R
authors.lastname: Suzuki
authors.affiliation: Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya.
authors.forename: K
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Division of Exploratory Research, the Institute of Medical Science, the University of Tokyo, Tokyo.
authors.forename: T
authors.initials: T
authors.lastname: Matsumura
authors.affiliation: Division of Exploratory Research, the Institute of Medical Science, the University of Tokyo, Tokyo.
authors.forename: K
authors.initials: K
authors.lastname: Yuji
authors.affiliation: Division of Genetic Therapeutics, Center for Molecular Medicine, Jichi Medical School, Tochigi.
authors.forename: Y
authors.initials: Y
authors.lastname: Kishi
authors.affiliation: Department of Transfusion Medicine, Metropolitan Fuchu Hospital, Tokyo.
authors.forename: T
authors.initials: T
authors.lastname: Hamaki
authors.affiliation: First Department of Internal Medicine, Nihon University School of Medicine, Tokyo.
authors.forename: U
authors.initials: U
authors.lastname: Sawada
authors.affiliation: Department of Radiology, Toyama Prefectural Central Hospital, Toyama.
authors.forename: S
authors.initials: S
authors.lastname: Miyata
authors.affiliation: Department of Chemotherapy, Tokyo Metropolitan Komagome Hospital, Tokyo.
authors.forename: T
authors.initials: T
authors.lastname: Sasaki
authors.affiliation: Hematology Division, National Cancer Center Hospital, Tokyo.
authors.forename: K
authors.initials: K
authors.lastname: Tobinai
authors.affiliation: Division of Respiratory Diseases, Toranomon Hospital, Tokyo.
authors.forename: M
authors.initials: M
authors.lastname: Kawabata
authors.affiliation: Division of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya.
authors.forename: Y
authors.initials: Y
authors.lastname: Atsuta
authors.affiliation: Third Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Tokyo.
authors.forename: Y
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Internal Medicine and Molecular Science, Nagoya City University School of Medicine, Nagoya.
authors.forename: R
authors.initials: R
authors.lastname: Ueda
authors.affiliation: Department of Clinical Pathology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D016724:Empyema, Pleural / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000473:pathology* / Q000628:therapy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology* / Q000628:therapy; D016399:Lymphoma, T-Cell / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011031:Pneumothorax, Artificial; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome