Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2024; 16(11): 4409-4423
Published online Nov 15, 2024. doi: 10.4251/wjgo.v16.i11.4409
Comparison of clinical features of patients with or without severe gastrointestinal complications in aggressive gastrointestinal lymphomas
Xiao-Hong Liu, Gong Chen, De-Dong Cao, Hui Liu, Xiao-Kang Ke, Yu-Gang Hu, Wei Tan, Dong Ke, Xi-Ming Xu
Xiao-Hong Liu, Gong Chen, De-Dong Cao, Xi-Ming Xu, Department of Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei Province, China
Hui Liu, Department of Hematology, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei Province, China
Xiao-Kang Ke, Department of Pathology, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei Province, China
Yu-Gang Hu, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei Province, China
Wei Tan, Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei Province, China
Dong Ke, Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei Province, China
Author contributions: Liu XH and Liu H designed the study and interpreted the data; Chen G, Ke XK, Ke D, Tan W and Cao DD contributed to the acquisition of the clinical samples and data; Hu YG, Cao DD, Liu XH and Xu XM performed the analytic calculations and wrote the manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: The study was approved by the Medical Ethics Committee of Renmin Hospital of Wuhan University, No. WDRY2021-KS024.
Informed consent statement: Patient consent was waived by the IRB because all patient data was de-identified.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Pathology data and the statistical analyses for the current study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xi-Ming Xu, Doctor, Chief Physician, Professor, Department of Cancer Center, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan 430000, Hubei Province, China. doctorxu120@aliyun.com
Received: July 17, 2024
Revised: August 25, 2024
Accepted: September 24, 2024
Published online: November 15, 2024
Processing time: 99 Days and 20.1 Hours
Abstract
BACKGROUND

Aggressive primary gastrointestinal non-Hodgkin lymphoma (PGINHL) is an uncommon and heterogeneous group of lymphoid malignancies, that differs from indolent lymphoma and has a high incidence of severe gastrointestinal complications (GICs).

AIM

To investigate and compare the clinicopathological characteristics, treatments and outcomes in the GICs and No-GICs group with aggressive PGINHL.

METHODS

This retrospective analysis was performed on aggressive PGINHL patients between January 2013 and December 2021 at our hospital. The independent influence factors of GICs were obtained by univariate and multivariate Logistic regression analysis, the selected variables significantly related to GICs were selected as the final predictors to construct nomogram. Kaplan-Meier curves further analyzed the survival of patients in GICs and No-GICs groups. Survival analysis of GICs group was performed using Cox regression.

RESULTS

We focused on 124 aggressive PGINHL cases, which had a relatively high incidence 48.4% (60/124 cases) of GICs, the most common histological type in GICs group was diffuse large B-cell lymphoma (DLBCL) (n = 49, 81.7%). In the GICs group, small intestine was the most common anatomic site of lesion (43.3%), followed by large intestine (31.7%), and then stomach and esophagus (25.0%). Multivariate Logistic regression analysis showed that the independent risk factors for GICs were the small intestine [odd ratio (OR) = 3.33; 95% confidence interval (CI): 1.47-9.41; P = 0.009), aggressive B-cell (OR = 0.09; 95%CI: 0.01-0.83; P = 0.033), maximum tumor diameter (OR = 1.25; 95%CI: 1.07-1.47; P = 0.005), invaded deep serous layer (OR = 3.38; 95%CI: 1.24-9.19; P = 0.017). We developed a nomogram to predict risk of GICs in aggressive PGINHL patients based on independent risk factors. The value of area under curve calculated by receiver operating characteristic curve was 0.815, and calibration curve and decision curve analysis further indicated that the prediction effect was superior. The majority of patients with GICs were given combination therapy (chemotherapy combined with surgery or radiation). Event-free survival and overall survival in GICs group were no worse than those in the No-GICs group.

CONCLUSION

The complication rate of GICs in patients with aggressive PGINHL was relatively high, particularly in PGI-DLBCL. The independent risk factors for GICs were the small intestine, PGI-TNKL, bulky tumor, and depth of invasion. A combination treatment, involving surgery, improved survival in the GICs group.

Keywords: Primary gastrointestinal; Aggressive; Non-Hodgkin lymphoma; Gastrointestinal complication; Risk factor

Core Tip: The characteristics of aggressive primary gastrointestinal non-Hodgkin lymphoma (PGINHL) with or without severe gastrointestinal complications (GICs) were explored in this study. The relationship between GICs and clinicopathological features of aggressive PGINHL patients, such as primary site, histological type, tumor size, depth of gastrointestinal invasion and other factors, was investigated by statistical analysis. The aim of this study was to summarize the risk factors and treatment strategies for aggressive PGINHL patients with or without GICs and to provide evidence-based evidence for clinical decision-making and individualized treatment strategies.