title: Primary Gastrointestinal Lymphoma: A Retrospective Multicenter Clinical Study of 415 Cases in Chinese Province of Guangdong and a Systematic Review Containing 5075 Chinese Patients.
abstract: Primary gastrointestinal lymphoma (PGIL) is a rare malignant tumor without standard diagnosis and treatment methods. This study is aimed to systematically analyze its clinical characteristics and draw out an appropriate flow chart of diagnosis and treatment process for PGIL in China.This study retrospectively analyzed the clinicopathological characteristics, diagnostic approaches, prognostic factors, and therapeutic modalities in 415 cases of PGIL in Chinese province of Guangdong. A systematic review was conducted in 118 studies containing 5075 patients to further identify clinical manifestations and mortalities of therapeutic modalities.The most common clinical presentations were abdominal pain and bloody stools. Endoscopic biopsy was an important diagnostic means, and usually more than once to make a definite diagnosis. Retrospective multicenter clinical study showed that younger onset age (<60 years), female, one region involved, one lesion, early stage, International Prognostic Index (IPI ≤1), normal lactate dehydrogenase (LDH), normal albumin, and nonemergency operation were significant prognostic factors for B-cell lymphoma; non-B symptom, tumor restricted to gastric or ileocecal region, one lesion, performance status (PS ≤1), normal LDH, and nonsurgery alone were significant prognostic factors for T-cell lymphoma. Site of origin and IPI were independent prognostic factors for B-cell lymphoma; PS was the independent prognostic factor for T-cell lymphoma. And T-cell lymphoma had worse overall survival (OS) and progression-free survival (PFS) than B-cell lymphoma. Among different therapeutic modalities, chemotherapy alone or combined with surgery showed better OS and PFS than surgery alone for diffuse large B-cell lymphoma (DLBCL) of stage I/II E and T-cell lymphoma. For DLBCL of stage III E/IV and mucosa-associated lymphoid tissue lymphoma, OS and PFS did not differ among different therapeutic groups. In meta-analysis, surgery plus chemotherapy showed lowest mortality.Chemotherapy alone or combined with surgery may be the first-line treatment for DLBCL of stage I/II E and T-cell lymphoma. A flow chart of diagnosis and treatment process for PGIL was approximately drew out.
authors.affiliation: From the Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation (YiC, SC, GL, KY, YL, KH); Department of Gastroenterology (YiC, SC, GL, KY, YL, KH), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Intensive Care Unit of Internal Medicine (YaC), The First Affiliated Hospital of Sun Yat-Sen University; Department of Ultrasound (LW), The Third Affiliated Hospital of Sun Yat-Sen University; Department of Gastroenterology (LX), Guangdong General Hospital, Guangzhou; and Department of Oncology (LZ), The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China.
authors.forename: Yinting
authors.initials: Y
authors.lastname: Chen
authors.forename: Yanzhu
authors.initials: Y
authors.lastname: Chen
authors.forename: Shaojie
authors.initials: S
authors.lastname: Chen
authors.forename: Lili
authors.initials: L
authors.lastname: Wu
authors.forename: Lishu
authors.initials: L
authors.lastname: Xu
authors.forename: Guoda
authors.initials: G
authors.lastname: Lian
authors.forename: Kege
authors.initials: K
authors.lastname: Yang
authors.forename: Yaqing
authors.initials: Y
authors.lastname: Li
authors.forename: Linjuan
authors.initials: L
authors.lastname: Zeng
authors.forename: Kaihong
authors.initials: K
authors.lastname: Huang
mesh_terms: D000367:Age Factors; D002681:China; D003131:Combined Modality Therapy; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008223:Lymphoma / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D016393:Lymphoma, B-Cell / Q000401:mortality / Q000473:pathology; D016399:Lymphoma, T-Cell / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis