title: Extranodal non-Hodgkin's lymphomas--a retrospective review of clinico-pathologic features and outcomes in comparison with nodal non-Hodgkin's lymphomas.
abstract: OBJECTIVE
  The primary objective of this study was to analyze the anatomic distribution, clinical features and outcome of Diffuse large B-cell lymphoma (DLBCL) patients according to the primary site (extranodal vs. nodal) with applicability of International Prognostic Index (IPI).
  
  
  METHODS
  A retrospective review (1988 to 2004) of 557 cases of DLBC.
  
  
  RESULTS
  The median age was 48.7 +/- 15.3 years; M:F ratio was 2:1. The distribution according to the primary site was: lymph node (N-NHL), 322 cases (58%) of which 145(44%) were stage IV, 76(23%) stage III, 60 (18%) stage II and 47 (15%) stage I. The extra nodal sites (EN-NHL) 235 (42%) cases included gastro-intestinal tract (44%), upper aerodigestive tract (19%), bones (8%), spine (5%), and unusual sites less than 3% each as breast, CNS, testis, lungs and skin. The median survival rate was 4.8 years and 6.3 years in N-NHL and EN-NHL respectively. In the latter this varied greatly depending on the primary site and stage of disease at presentation. In the univariate analysis factors associated with good prognosis were: age less than 60 years, early stage (I-II), extranodal involvement primarily gastric or bone, 0-1 extranodal site, 0-1 performance status, lack of B symptoms and normal LDH level. In the multivariate analysis age, performance status, stage of disease and level of LDH were the main variables predicting overall survival; no nodal or extranodal site maintained their prognostic value.
  
  
  CONCLUSIONS
  Patients with EN-NHL present more frequently with early stage disease then those with N-NHL; overall survival in both groups largely depended on IPI and not on the site of origin of the malignancy.
authors.affiliation: Division of Medical Oncology and Hematology, Aga Khan University, Karachi, Pakistan.
authors.forename: Amar
authors.initials: A
authors.lastname: Lal
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Bhurgri
authors.forename: Irfan
authors.initials: I
authors.lastname: Vaziri
authors.forename: Nida B
authors.initials: NB
authors.lastname: Rizvi
authors.forename: Aliyah
authors.initials: A
authors.lastname: Sadaf
authors.forename: Saba
authors.initials: S
authors.lastname: Sartajuddin
authors.forename: Mohammed
authors.initials: M
authors.lastname: Islam
authors.forename: Pawan
authors.initials: P
authors.lastname: Kumar
authors.forename: Salman
authors.initials: S
authors.lastname: Adil
authors.forename: Ghulam Nabi
authors.initials: GN
authors.lastname: Kakepoto
authors.forename: Nehal
authors.initials: N
authors.lastname: Masood
authors.forename: Mohammed
authors.initials: M
authors.lastname: Khurshed
authors.forename: Amyn
authors.initials: A
authors.lastname: Alidina
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001707:Biopsy, Needle; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D054391:Lymphoma, Extranodal NK-T-Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D016017:Odds Ratio; D010154:Pakistan; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis