Clinical management and susceptibility of primary hepatic lymphoma: A cases-based retrospective study

Table 1 Clinical characteristics of recruited patients

Characteristics	Patient numbers (%) (n = 116)
Age, median (range)	58.5 (19-92)
Years of diagnosis
1999-2009	36 (31.8)
2009-2019	80 (68.2)
Sex
Male	72 (62.1)
Female	44 (37.9)
Presentation
Abdominal pain	58 (50.0)
Fatigue	21 (18.1)
Nausea and vomiting	13 (11.2)
Anorexia	7 (6.0)
Hepatomegaly	53 (45.6)
Splenomegaly	9 (7.7)
Asymptomatic	14 (12.0)
Lesion
Single/multiple/diffused/bulky	58 (50.0)/23 (19.8)/33 (28.4)/29 (25.0)
Lactate dehydrogenase
Elevated/normal	55 (47.4)/58 (52.6)
B symptoms
Loss of weight/fever/night sweat	39 (33.6)/36 (31.0)/9 (7.7)
Infection
HBV/HCV/EBV	15 (12.9)/12 (10.3)/9 (7.7)
Immunosuppressive status
Autoimmune disease	13 (11.2)
Rheumatic Arthritis	7 (6.0)
HIV	7 (6.0)
Differential diagnosis
HCC	21 (18.1)
Metastasis	18 (15.5)
Abscess or infection	12 (10.3)
ICC	10 (8.6)
Cholecystitis	5 (4.3)
Pseudolymphoma	4 (3.4)
Hemangioma	4 (3.4)
Treatment
Surgery	36 (31.0)
Chemotherapy/R-CHOP/CHOP	86 (74.1)/55(47.4)/10(8.6)
Radiotherapy	6 (5.1)
PHL subtypes
B cell lymphoma	99 (85.3)
DLBCL/MALT/HL/BL/FL/HGBCL	72 (62.1)/14(12.0)/4(3.4)/3(2.5)/3(2.5)/3(2.5)
T cell lymphoma	7 (6.0)
Other unclassified1	10 (11.6)
Region
Asia	72 (62.1)
Japan/China/India/South Korea	24 (20.6)/17(14.6)/16(13.7)/8(6.8)
Other	7 (6.0)
Europe	20 (17.2)
North America	15 (12.9)

¹The diagnosis of primary hepatic lymphoma was confirmed, but there was no specific subtype classification. HBV: Hepatitis B virus; HCV: Hepatitis C virus; EBV: Epstein-Barr virus; HCC: Hepatocellular carcinoma; ICC: Intrahepatic cholangiocarcinoma; R-CHOP: Rituximab with cyclophosphamide, doxorubicin, vincristine and prednisone; DLBCL: Diffuse large B-cell lymphoma; MALT: Mucosa-associated lymphoid tissue lymphoma; TCL: T cell lymphoma; HL: Hodgkin lymphoma; BL: Burkitt lymphoma; FL: Follicular lymphoma; HGBCL: High grade B cell lymphoma; Other: 1 primary plasmacytic hepatic lymphoma and 1 anaplastic large cell lymphoma.

Table 2 Methods of liver biopsy

Methods	Numbers	Positive rate (%)
Surgery	36	100.0
Diagnostic	27
Therapeutic	9
Ultrasound-guided	69	92.81
CT-guided	10	90.01
Transjugular	4	100.0
Laparoscopic	3	100.0

¹Each of them has only one uncertain results. CT: Computed tomography.

Table 3 Characteristics of 20 immunocompromised patients and treatment

Age	Latency (years)	HIV	Autoimmune disease	Immunosuppressive agents	Subtype	Treatment
73	8	-	RA	MTX; Prednisone; Cyclophosphamide	DLBCL	Chemo + DOD
89	-	-	PBC	-	MALT	Chemo
55	11	+	-	-	HL	Surgery + Chemo
65	7	-	RA	MTX	DLBCL	Surgery + DOD
65	-	-	CTD	Azathioprine; Prednisone; Hydroxychloroquine	DLBCL	Chemo
63	10	-	RA	MTX	DLBCL	DOD
32	-	+	-	-	DLBCL	Chemo
56	7	-	RA	MTX	DLBCL	Chemo + DOD
64	2	-	RA	MTX; Infliximab	DLBCL	Chemo + DOD
67	38	-	RA	MTX; Prednisone	DLBCL	Chemo + DOD
36	10	-	ITP	MTX; Azathioprine; Steroid	DLBCL	Chemo
45	8	-	Renal transplanted	Tacrolimus; Azathioprine; Prednisone	DLBCL	-
56	-	+	-	-	Unclassified	-
64	3	-	AIHA	Corticosteroids; Rituximab; Alemtuzumab	DLBCL	Chemo
48	4	-	RA	MTX	DLBCL	DOD
27	-	+	-	-	HGBCL	-
43	-	+	-	-	ALCL	-
34	11	+	-	-	DLBCL	Chemo
62	18	-	SS	Cyclophosphamide; Prednisolone	DLBCL	Chemo + DOD
32	1	+	-	-	BL	Chemo

RA: Rheumatoid arthritis; SS: Sjogren's syndrome; PBC: Primary biliary cirrhosis; HIV: Human immunodeficiency virus; DLBCL: Diffuse large B-cell lymphoma; ALCL: Anaplastic large cell lymphoma; HL: Hodgkin lymphoma; BL: Burkitt lymphoma.

Table 4 Univariate and multivariate Cox regression for analyzing the risk factors for primary hepatic lymphoma patients

Variables	Univariate			Multivariate
	HR	95%CI	P value	Adjusted HR	95%CI	P value
Sex
Female	Ref.
Male	1.442	0.582-3.574	0.429	NA	NA	NA
Age (years)
< 60	Ref.
≥ 60	1.101	0.468-2.593	0.825	NA	NA	NA
Virus infection
Unknown	Ref.
Yes	1.009	0.370-2.756	0.985	NA	NA	NA
LDH
Normal	Ref.			Ref.
Elevated	3.023	1.172-7.797	0.022	1.901	0.667-5.416	0.229
Liver function
Normal	Ref.			Ref.
Abnormal	2.747	1.108-6.813	0.030	1.333	0.477-3.730	0.584
B symptom
No	Ref.			Ref.
Yes	2.810	1.090-7.246	0.032	1.785	0.654-4.872	0.258
Hepatosplenomegaly
No	Ref.			Ref.
Yes	2.971	1.152-7.663	0.024	1.925	0.697-5.466	0.203
Lesion
Single	Ref.			Ref.
Multiple or diffused	2.743	1.064-7.075	0.037	1.992	0.753-5.276	0.165

HR: Hazard ratio; CI: Confidence interval; LDH: Lactate dehydrogenase; NA: No application.