title: Analysis of outcomes in patients with supra-diaphragmatic vs infra-diaphragmatic diffuse large B cell lymphoma treated with R-CHOP therapy.
abstract: The prognostic implications of infra-diaphragmatic (InD) versus supra-diaphragmatic (SpD) primary lesions in limited-stage diffuse large B-cell lymphoma (DLBCL) remains unknown. This retrospective study aimed to assess the prognostic impact of spD and InD lesions as well as presence of gastrointestinal (GI) involvements in adults with limited-stage DLBCL. We analyzed data from 178 patients with limited-stage DLBCL who were treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone therapy at 7 institutions of the Yokohama City University Hematology Group between 2003 and 2009. The median age was 63 years (range, 18-80 years). The primary sites were SpD in 109 patients, and InD in 69. No statistical differences in progression-free survival (PFS) or overall survival (OS) were observed between patients with SpD lesions and those with InD lesions. However, when patients with SpD lesions, InD lesions with (n=35), and without (n=34) GI involvement were compared, the presence of GI lesions was associated with favorable PFS. The multivariate analysis revealed that SpD or InD localization had no independent effect on PFS or OS, whereas the presence of GI lesions was correlated with favorable PFS (P=0.024, HR 0.09).
authors.affiliation: Department of Internal Medicine and Clinical Immunology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan. Electronic address: yuki1234@yokohama-cu.ac.jp.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Nakajima
authors.affiliation: Department of Internal Medicine and Clinical Immunology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Tomita
authors.affiliation: Department of Hematology, Yokohama City University, Medical Center, Yokohama, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Itabashi
authors.affiliation: Department of Hematology/Immunology, Fujisawa City Hospital, Fujisawa, Japan.
authors.forename: Kazuho
authors.initials: K
authors.lastname: Miyashita
authors.affiliation: Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Reina
authors.initials: R
authors.lastname: Watanabe
authors.affiliation: Department of Internal Medicine and Clinical Immunology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: Department of Internal Medicine and Clinical Immunology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tachibana
authors.affiliation: Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Takasaki
authors.affiliation: Department of Hematology/Immunology, Fujisawa City Hospital, Fujisawa, Japan.
authors.forename: Rika
authors.initials: R
authors.lastname: Kawasaki
authors.affiliation: Department of Hematology, Yokohama City University, Medical Center, Yokohama, Japan.
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Department of Hematology/Oncology, Yamato Municipal Hospital, Yamato, Japan.
authors.forename: Chizuko
authors.initials: C
authors.lastname: Hashimoto
authors.affiliation: Department of Internal Medicine and Clinical Immunology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan.
authors.forename: Etsuko
authors.initials: E
authors.lastname: Yamazaki
authors.affiliation: Department of Hematology, Shizuoka Red Cross Hospital, Shizuoka, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Taguchi
authors.affiliation: Department of Hematology/Immunology, Fujisawa City Hospital, Fujisawa, Japan.
authors.forename: Katsumichi
authors.initials: K
authors.lastname: Fujimaki
authors.affiliation: Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Rika
authors.initials: R
authors.lastname: Sakai
authors.affiliation: Department of Hematology, Shizuoka Red Cross Hospital, Shizuoka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Fujita
authors.affiliation: Department of Hematology, Yokohama City University, Medical Center, Yokohama, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Fujisawa
authors.affiliation: Department of Hematology, Yokosuka City Hospital, Yokosuka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Harano
authors.affiliation: Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Motomura
authors.affiliation: Department of Internal Medicine and Clinical Immunology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ishigatsubo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003520:Cyclophosphamide / Q000008:administration & dosage; D003964:Diaphragm; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000473:pathology; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D012189:Retrospective Studies; D000069283:Rituximab; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone
keywords: Diffuse large B-cell lymphoma; Gastrointestinal involvement; Infra-diaphragmatic; Prognostic factor; Supra-diaphragmatic