Clinical Characteristics and Outcome of 41 Patients with Upper GI Diffuse B-Cell Non-Hodgkin Lymphoma. Results of Brazilian-Italy Lymphoma Registry
Authors: Delamain Marcia T , Miranda Eliana C M , Francesco Merli , Chiattone Carlos S , Fedina Anna , Luminari Stefano , De Souza Carmino Antonio , Massimo Federico 
Published: October 2019

Abstract
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 1st 2010 and May 1st 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.

Disclosures
No relevant conflicts of interest to declare.