A 10-year cohort study of 175 primary gastrointestinal lymphoma cases in Thailand: clinical features and outcomes in the immunochemotherapy era

Figures & data

Table 1. Clinical characteristics and initial investigations.

PGIL patients (N = 175)	Frequency (Percent)
Sex
- Male	105 (60)
- Female	70 (40)
Age (years), median (range)	60 (20–98)
ECOG-PS
- ECOG 0	1 (0.6)
- ECOG 1	83 (47.4)
- ECOG 2	72 (41.1)
- ECOG 3	17 (9.7)
- ECOG 4	1 (0.6)
- Unknown	1 (0.6)
Ann Arbor Staging
- 1	54 (30.9)
- 2	35 (20.0)
- 3	18 (10.3)
- 4	52 (29.7)
- Unknown due to lacking of bone marrow study performed	16 (9.1)
Clinical presentation
- Abdominal pain (n = 174)	144 (82.8)
- Palpable abdominal mass (n = 174)	51 (29.3)
- Dysphagia (n = 172)	12 (7.0)
- Gut obstruction (n = 174)	19 (10.9)
- Perforation (n = 173)	18 (10.4)
- Upper GI bleeding (n = 174)	35 (20.1)
- Lower GI bleeding (n = 174)	21 (12.1)
- Malabsorption syndrome (n = 173)	2 (1.2)
- Chronic diarrhea (n = 173)	18 (10.4)
- Constipation (n = 175)	10 (5.7)
- Significant weight loss (n = 174)	88 (50.6)
- Fever (n = 174)	22 (12.6)
- Night sweat (n = 174)	5 (2.9)
- Jaundice (n = 173)	4 (2.3)
- Superficial lymphadenopathy (n = 173)	14 (8)
Initial investigations
Complete blood count
- Hemoglobin (g/dl; mean ± SD)	10.6 ± 2.2
- White blood cell counts (x10^9/l; median, range)	7.59 (0.66–46)
- Platelet counts (x10^9/l, median, range)	277 (17–803)
Liver function test
- Albumin (g/dl; mean ± SD)	3.3 ± 0.8
- Globulin (g/dl; mean ± SD)	3.5 ± 1.0
- Total bilirubin level (mg/dl; median, range)	0 (0–13)
- Direct bilirubin level (mg/dl; median, range)	0 (0–12)
- Aspartate transaminase (U/l; median, range)	22 (9–602)
- Alanine transaminase (U/l; median, range)	15 (3–315)
- Alkaline phosphatase (U/l; median, range)	75 (25–1,843)
Lactate dehydrogenase (U/l; median, range)	380 (201–7,208)

Abbreviations: ECOG-PS, Eastern Cooperative Oncology Group-Performance status; PGIL, Primary gastrointestinal lymphoma; SD, standard deviation.

Table 2. Sites of gastrointestinal involvement, lymphoma subtypes, and treatments.

PGIL patients	Frequency (Percent)
GI organ involvement
- Stomach	68 (38.9)
- Small intestine	41 (23.4)
- Large intestine	25 (14.3)
- Multiple organ involvements	41 (23.4)
Lymphoma subtypes
- DLBCL	107 (61.1)
- BL	7 (4.0)
- MALT	23 (13.1)
- FL	5 (2.9)
- SLL/CLL	9 (5.1)
- MCL	8 (4.6)
- PTCL, NOS	6 (3.4)
- EATL	2 (1.1)
- ALCL	1 (0.6)
- NKTCL	5 (2.9)
- HL	1 (0.6)
- B-cell lymphoma, unclassified	1 (0.6)
Treatment
- H.pylori treatment (only positive case; n = 33)	33 (100)
- HIV treatment (only positive case; n = 4)	3 (75)
- HBV treatment (only positive case; n = 23)	11 (47.8)
- HCV treatment (only positive case; n = 5)	1 (20)
- Excision (n = 168)	59 (35.1)
- Radiotherapy (n = 167)	12 (7.2)
- Chemotherapy (n = 163)	121 (74.2)

Abbreviations: BL, Burkitt lymphoma; EATL, enteropathy-associated T-cell lymphoma; FL, follicular lymphoma; GI, gastrointestinal; HBV, Hepatitis B virus; HCV, Hepatitis C virus; HIV, Human immunodeficiency virus; HL, Hodgkin lymphoma; H. pylori, Helicobacter pylori; MALT, marginal zone lymphoma; MCL, mantle cell lymphoma; NKTCL, NK/T-cell lymphoma; PGIL, Primary gastrointestinal lymphoma; PTCL-NOS, peripheral T-cell lymphoma-not otherwise specified; SLL/CLL, small lymphocytic lymphoma/chronic lymphocytic leukemia.

Figure 1. Overall survival curves of PGIL.

Figure 2. Overall survival curves according to (A) age groups (P-value = 0.352); (B) ECOG-PS (P-value = 0.015).

Figure 3. Overall survival curves according to (A) sites of lymphoma involvement (P-value = 0.036); (B) Staging groups (P-value = 0.528).

Figure 4. Overall survival curves according to (A) lymphoma groups (P-value = 0.005); (B) Rituximab exposure groups (P-value = 0.128).

Table 3. Univariate and multivariate analyses for overall survival in PGIL patients (months).

Univariate	N	Median overall survival (months)	P-value	HR (95% CI)
Age	111		.356
≤60 years	59	NR		1
>60 years	52	70.5		1.37 (0.70–2.67)
ECOG performance scale	111		.018
0–1	58	NR		1
2–4	53	60.3		2.27 (1.15–4.48)
Sites of lymphoma involvement	99		.042
Gastric	42	NR		1
Intestine	57	69.2		2.31 (1.03–5.17)
Ann Arbor stage	101		.530
Limited (stage I-II)	57	77.3		1
Advanced (stage III-IV)	54	NR		0.80 (0.40–1.61)
Lymphoma group	110		.011
Indolent	24	NR		1
Aggressive	86	70.5		4.63 (1.41–15.20)
Rituximab exposure	79
No rituximab treatment	44	69.2	.136	1
Rituximab-consisted treatment	35	NR		0.52 (0.22–1.23)
Multivariate	P-value	HR (95% CI)
ECOG performance scale	.001	7.04 (2.20–22.52)
Sites of lymphoma involvement	.146	2.05 (0.78–5.40)
Lymphoma groups	.052	3.99 (0.99–16.14)
Rituximab exposure	.004	6.08 (1.77–20.88)

A p-value < 0.05 indicates statistical significance.

Abbreviations: CI, confidence interval; ECOG, Eastern Cooperative Oncology Group; HR, Hazard ratio; NR, Not reached.