Clinical outcomes and prognostic factors in patients with breast diffuse large B cell lymphoma; Consortium for Improving Survival of Lymphoma (CISL) study.
BACKGROUND
The breast is a rare extranodal site of non-Hodgkin lymphoma, and primary breast lymphoma (PBL) has been arbitrarily defined as disease localized to one or both breasts with or without regional lymph nodes involvement. The aim of this study was to evaluate the clinical outcomes in patients with diffuse large B cell lymphoma (DLBCL) and breast involvement, and to find the criteria of PBL reflecting the outcome and prognosis.


METHODS
We retrospectively analyzed data from 68 patients, newly diagnosed with DLBCL and breast involvement at 16 Korean institutions between January 1994 and June 2009.


RESULTS
Median age at diagnosis was 48 years (range, 20-83 years). Forty-three (63.2%) patients were PBL according to previous arbitrary criteria, sixteen (23.5%) patients were high-intermediate to high risk of international prognostic index. The patients with one extranodal disease in the breast (OED) with or without nodal disease were 49 (72.1%), and those with multiple extranodal disease (MED) were 19 (27.9%). During median follow-up of 41.5 months (range, 2.4-186.0 months), estimated 5-year progression-free survival (PFS) was 53.7 +/- 7.6%, and overall survival (OS) was 60.3 +/- 7.2%. The 5-year PFS and OS was significantly higher for patients with the OED group than those with the MED group (5-year PFS, 64.9 +/- 8.9% vs. 27.5 +/- 11.4%, p = 0.001; 5-year OS, 74.3 +/- 7.6% vs. 24.5 +/- 13.0%, p < 0.001). In multivariate analysis, MED (hazard ratio [HR], 3.61; 95% confidence interval [CI], 1.07-12.2) and fewer than four cycles of systemic chemotherapy with or without local treatments (HR, 4.47; 95% CI, 1.54-12.96) were independent prognostic factors for worse OS. Twenty-five (36.8%) patients experienced progression, and the cumulative incidence of progression in multiple extranodal sites or other than breasts and central nervous system was significantly different between the OED group and the MED group (5-year cumulative incidence, 9.7 +/- 5.4% vs. 49.0 +/- 15.1%, p = 0.001).


CONCLUSIONS
Our results show that the patients included in OED group, reflecting different treatment outcome, prognosis and pattern of progression, should be considered as PBL in the future trial. Further studies are warranted to validate our suggested criteria.
Yhim
Ho-Young
HY
Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.
Kang
Hye Jin
HJ
Choi
Yoon Hee
YH
Kim
Seok Jin
SJ
Kim
Won Seog
WS
Chae
Yee Soo
YS
Kim
Jin Seok
JS
Choi
Chul Won
CW
Oh
Sung Yong
SY
Eom
Hyeon Seok
HS
Kim
Jeong-A
JA
Lee
Jae Hoon
JH
Won
Jong-Ho
JH
Shim
Hyeok
H
Lee
Je-Jung
JJ
Sung
Hwa Jung
HJ
Kim
Hyo Jung
HJ
Lee
Dae Ho
DH
Suh
Cheolwon
C
Kwak
Jae-Yong
JY
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016009:Chi-Square Distribution; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000145:classification / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult