Clinical Characteristics and Outcome of 41 Patients with Upper GI Diffuse B-Cell Non-Hodgkin Lymphoma. Results of Brazilian-Italy Lymphoma Registry

Background: Gastrointestinal lymphoma represents only 1-4% of the malignant tumors in the gastrointestinal tract and is the most common extranodal site among all types of Non- Hodgkin Lymphomas (NHL). Only 3% of gastric neoplasms are primary lymphomas.

Aim: Identification of factors with a potential prognostic impact among all cases with aggressive gastric diffuse large B-cell lymphoma - the clinical characteristics, the response to therapy and overall survival in the Brazilian-Italy Lymphoma registry.

Patients and Methods: Between January 1^st 2010 and May 1^st 2014, 267 patients with DLBCL were recorded of which 41 (15%) had gastric involvement. The following parameters were evaluated to establish correlations with the response to treatment and survival data: clinical symptoms, serum albumin, serum lactate dehydrogenize (LDH), b2 microglobulin, presence of local regional adenopathies, bulky tumor, stage of disease, international prognostic index (IPIa), type of treatment – surgery plus chemotherapy.

Results: A total of 41 patients, with a median age of 69 (28-86) years, were enrolled in this study, with a female: male ratio of 1.7:1. Their ECOG performance status was distributed in 44% grade 0; 34% grade 1; 14.6% grade 2 and 7.4% grade 3, whereas IPIa classification was 5 (12.2%) patients with high risk; 14 (34.2%) high-intermediate risk and 22 (53.6%) low- intermediate risk.Stage III-IV was presented in 66% of cases. LDH values were elevated in 17 patients (41.5%), b2 microglobulin value were elevated in 31 patients (75.6%). The test for identification of Helicobacter Pillory (HP) was available in 33 patients and was positive in 9 patients (27%). The most common symptoms included abdominal pain and weight loss (both 86%), dysphagia (80%) and nausea, vomiting (74%). Bulky were found in 27%, plus anemia (44%) and bleeding (25%). Endoscopic examination was realized in 94%, however, only 8% was submitted to surgery. 39 patients received chemotherapy (84% R-CHOP), one Brazilian case died early and one Italian case was lost follow up. Overall 17.5% (7/40) received radiotherapy. The median follow-up time was 14 (1-71) months, with 1-, 2- and 5-year survival rates of 73, 63 and 58%, respectively. It was found the 5-year overall survival (OS) rate differed significantly according to Anemia (p= 0.02) and LDH at the diagnosis (p< 0.0001). Among Brazilian and Italian patients the difference clinical characteristics were B symptoms (p=0.02); weight loss (p= 0.003); nausea/vomiting (p= 0.002); pain and dysphagia (p< 0.0001); showing a wider severity in Brazilian group. Although it did not mean a worst outcome. There was no statistically significant differences in terms of OS according to gender (p=0.19); B symptoms (p= 0.12); bleeding at the diagnosis (p= 0.08) and clinical stage (p= 0.14). Furthermore, the only confirmed factor that influenced OS applying Cox Regression was the LDH (HR 8.74, 95% CI: 2.32-32.8; p= 0.001).

In conclusion, the median follow-up time of DLBCL group with gastric involvement does not differ in relation to overall DLBCL patients; nevertheless, it was found negative factors for these patients: anemia and increased LDH at the diagnosis. Furthermore, in the Brazilian patients the HP researching is necessary due the high frequency in this population.