Primary diffuse large B-cell lymphoma of the breast: prognostic factors and outcomes of a study by the International Extranodal Lymphoma Study Group.
BACKGROUND
Primary diffuse large B-cell lymphoma (DLBCL) of breast is rare. We aimed to define clinical features, prognostic factors, patterns of failure, and treatment outcomes.


METHODS
A retrospective international study of 204 eligible patients presenting to the International Extranodal Lymphoma Study Group-affiliated institutions from 1980 to 2003.


RESULTS
Median age was 64 years, with 95% of patients presenting with unilateral disease. Median overall survival (OS) was 8.0 years, and median progression-free survival 5.5 years. In multifactor analysis, favourable International Prognostic Index score, anthracycline-containing chemotherapy, and radiotherapy (RT) were significantly associated with longer OS (each P < or = 0.03). There was no benefit from mastectomy, as opposed to biopsy or lumpectomy only. At a median follow-up time of 5.5 years, 37% of patients had progressed--16% in the same or contralateral breast, 5% in the central nervous system, and 14% in other extranodal sites.


CONCLUSIONS
The combination of limited surgery, anthracycline-containing chemotherapy, and involved-field RT produced the best outcome in the pre-rituximab era. A prospective trial on the basis of these results should be pursued to confirm these observations and to determine whether the impact of rituximab on the patterns of relapse and outcome parallels that of DLBCL presenting at other sites.
Ryan
G
G
Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia. gail.ryan@petermac.org
Martinelli
G
G
Kuper-Hommel
M
M
Tsang
R
R
Pruneri
G
G
Yuen
K
K
Roos
D
D
Lennard
A
A
Devizzi
L
L
Crabb
S
S
Hossfeld
D
D
Pratt
G
G
Dell'Olio
M
M
Choo
S P
SP
Bociek
R G
RG
Radford
J
J
Lade
S
S
Gianni
A M
AM
Zucca
E
E
Cavalli
F
F
Seymour
J F
JF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007391:International Cooperation; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012955:Societies, Medical; D016019:Survival Analysis