Surgery and Chemotherapy versus Chemotherapy Only in Older Persons with Primary Intestinal Diffuse Large B-Cell Lymphoma

Abstract

Background

The management of primary intestinal diffuse large B cell lymphoma (PI-DLBCL) in elderly patients (aged >60 years) remains controversial. We conducted a retrospective study to assess the efficacy of different treatment strategies and prognostic factors for elderly Chinese patients with PI-DLBCL.

Patients and Methods

Forty-six untreated elderly patients with PI-DLBCL were included in this retrospective study. Twenty-four patients were treated with surgery (prior to chemotherapy) plus chemotherapy (SCT). The other 22 patients did not undergo surgery before chemotherapy (CT).

Results

Patients treated with SCT had a higher overall response rate of 91.7% than patients receiving CT, but the difference between groups was not significant (P=0.581). Regarding survival, SCT resulted in a greater 3-year overall survival (OS) rate (87.3% vs 56.9%, P=0.130) and significantly higher 3-year event-free survival (EFS) rate (74.1% vs 27.3%, P=0.002) than CT. The univariate analysis showed that male sex, advanced Lugano stage, poor performance status and chemotherapy alone were associated with a shorter EFS. Only the male sex was correlated with a shorter OS. The multivariate analysis showed that sex (P=0.040) and treatment strategy (P=0.022) were independent prognostic factors for EFS.

Conclusion

Surgery plus chemotherapy produced a better outcome for EFS, but not OS, than chemotherapy alone in elderly Chinese patients with PI-DLBCL.

Keywords:

• PI-DLBCL
• surgery
• chemotherapy
• survival
• prognostic factors

Ethics Statement

The study was approved by the Institutional Review Board and Ethics Committee of Sun Yat-sen University Cancer Center. Our study was a retrospective study, and thus the ethics committee exempted the informed consent requirement for patients. Our study adheres to the principles of the Declaration of Helsinki. All included patient data were confidential.

Author Contributions

TYL and YL designed the study. LMZ, HH and ZW collected and analysed the data. LMZ, HH and RPG wrote and revised the manuscript. All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

Yang Liang is supported in part by Sun Yat-sen University Start-up Funding, Grant 201603, the Program for Guangdong Introducing Innovative and Entrepreneurial Teams (2017ZT07S096) and the National Natural Science Foundation of China (Grant No. 81873428). RPG acknowledges support from the National Institute of Health Research (NIHR) Biomedical Research Centre funding scheme. RPG also reports personal fees from Ascentage Pharma Group, BeiGene LTD, Kite Pharma, Inc, Fusion Pharma LLC, La Jolla NanoMedical, Mingsight Pharmaceuticals, Prolacta Bioscience, CStone Pharmaceuticals, FFF Enterprises, Inc., and Antegene Biotech, LLC, outside the submitted work. The authors report no other conflicts of interest in this work.