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Clinicopathological Features, Treatment Strategy, and Prognosis of Primary Non-Hodgkin's Lymphoma of the Duodenum: A SEER Database Analysis.

1. Introduction

The most predominant extranodal site in non-Hodgkin's lymphoma (NHL) is the gastrointestinal (GI) tract [1], accounting for 5% to 20% of all NHL cases and 30% to 45% of all extranodal cases [2]. The lesion can occur in any part of the digestive tract from the mouth to the anus, of which stomach is the most common pathogenic sites (60%-75%) [3].

As primary duodenum lymphomas (PDLs) are exceedingly rare, the current researches about PDLs are based on anecdotal reports [4-23]. In the present study, we retrospectively reviewed the clinical and pathological manifestations of lymphomas of duodenum lymphoma for cases based on the largest sample size so far to identify prognostic factors and to clarify the value of treatment modalities in the management of these malignancies.

2. Materials and Methods

2.1. Data Source and Patient Selection. We queried the SEER database (SEER, 18 November 2017) with SEER Stat version 8.3.5 software to identify 14872 patients who were diagnosed with lymphoma from 1998 to 2015, including 1060 PDLs, 10573 primary gastric lymphomas (PGLs), and 3239 primary small intestinal lymphomas (PSILs). The codes used for lymphoma in the coding system of the International Classification of Diseases for Oncology (ICD-O)-3 were 9590-9729. The search was limited to adult patients ([greater than or equal to] 18 years old) with the type of follow-up equal to "active follow-up." The exclusion criteria were as follows: (i) patients without definitely histological confirmation; (ii) patients with only autopsy or death certificate records; (iii) patients with incomplete survival data and follow-up information; (iv) patients without Ann Arbor stage record; and (v) patients without the information of surgery. After screening, we got a total of 10321 patients.

Clinical and pathological variables (e.g., age, gender, race, sex, age at diagnosis, marital status, year of diagnosis, histological type, Ann Arbor stage, whole body symptom of lymphoma based on the AJCC (6th edition) staging system, treatment modalities employed and information of "cause of death and follow-up," and "multiple primary field") were extracted from the SEER.

Since the SEER cause-specific death classification variable is defined by taking into account cause of death in conjunction with sequence of tumor occurrence (ie, only one tumor or the first of multiple tumors) and comorbidities (e.g., AIDS and/or site-related diseases), we excluded the patients except that lymphoma was the only one primary cancer or the 1st cancer of 2 or more primaries to avoid the ambiguity of the lymphoma-specific survival [24].

The survival data were available in the measurement unit of months, without precise days. Considering the preconditions that no precise survival days were available and that patients with only autopsy or death certificate records were excluded, a survival time of 0 months was recorded as 0.5 months to include patients who died within 1 month of diagnosis but who did not reach the 1-month threshold [25,26].

Since this study only involves analysis of the publically available database (SEER) and does not contain any identifying patient information, the ethical approval of this study by the institutional review board (IRB) is not required.

2.2. Statistical Analyses. Statistical analyses were performed using the statistical software SPSS 22.0 for Apple (SPSS Inc., Chicago, IL). Numerical variables were expressed as mean [+ or -] SD and were analyzed by the t-test. Discrete variables were analyzed using the chi-square test or Fisher's exact test. Risk factors for survival were identified by univariate analysis, and COX regression was employed for multivariate analysis. Disease-specific survival (DSS) was analyzed by the Kaplan-Meier method and differences between the curves were compared using the log-rank test. All P values were two-sided, and P values < 0.05 were considered statistically significant.

3. Results

3.1. Baseline Demographic Characteristics. Clinical and pathological features of primary duodenum lymphoma (PDL) are summarized in Table 1. In total, 1060 eligible PDL patients were recognized during the 18-year study period (between 1998 and 2015). There was no obvious sex trend: 604 were male and 456 were female. Age was from 7 to 99 years (median, 62 years; mean, 60.96 [+ or -] 15.205 years). Most patients were married (611; 57.65%) and white (878; 82.83%). 55.66% of the patients had clear symptoms, of which the symptoms of A were 463 (43.68%) and B were 127 (11.98%). Out of 1060 PDL specimens, follicular lymphoma (FL) was observed in 436 (41.13%) of them, and diffuse large B-cell lymphoma (DLBCL) in 348 of the tumor specimens (32.83%) was observed. The majority of patients (949, 89.85%) had single tumor, and only 111 (10.47%) patients had multiple tumors. Among 1060 patients, 92 underwent surgery alone or associated with conservative treatment (chemotherapy alone, radiotherapy alone, chemotherapy + radiotherapy, or Helicobacter pylori eradication only), and the other 968 received conservative treatment.

Next, clinical and pathological features of 1060 PDLs were compared with those of 10573 PGLs and 3239 PSILs (Table 2). The results showed that there were no significant differences in age, gender, marital status, race, and other cancers between the surgery and conservative groups. However, primary site, Ann Arbor staging, symptoms, and histological type were significantly different between the two groups (all P < 0.05); that is, incidence of cancers with I stage or A symptoms was significantly higher in the conservative group compared to that in the surgery group.

The results showed that age, gender, symptom, and histological type were significantly different between PDLs and PGLs (all P < 0.05); that is, incidence of tumors with younger patients or more follicular lymphoma was significantly higher in the PDL group compared to that in the PGL group. The PDL group also showed younger patients, earlier Ann Arbor staging, more follicular lymphoma, and more surgery treatment in comparison with those of the PSIL group (all P < 0.05).

3.2. Survival and Prognostic Factors. In order to analyze the prognosis among duodenum, gastric, and small intestinal lymphomas, survivals of 1060 PDLs were compared to those of 10573 PGLs and 3239 PSILs (Figure 1). The results showed that the DSS of PDLs were significantly better than those of PGLs and PSILs (10-year survival rate: 21.24% vs. 20.40%, P = 0.027; 10-year survival rate: 21.24% vs. 16.79%, P = 0.001).

Furthermore, univariate and multivariate analyses were performed to evaluate the prognosis of PDLs (Table 3). Age, gender, Ann Arbor staging, and histological type were regarded as independent prognostic factors for the DSS (all P < 0.05). Symptom was regarded as a significant risk factor for the DSS by univariate analysis (P = 0.002), while it is not an independent prognostic factor for DSS by multivariate analysis.

3.3. Stratified Analysis. We showed stratified analysis according to several prognostic variables based on multivariate analyses (Figure 2). Patients with <65 years, female, stage I, and FL were found to be significantly associated with good DSS. However, patients with >60 years, male, stage IV, and TCL were found to be significantly associated with poor DSS (all P < 0.05).

Figure 3 shows the changing trend of treatment modalities to PGL. The changing trends of treatment modalities to PDL were analyzed in 4 consecutive time periods: from 1998 to 2000 (period 1), from 2001 to 2005 (period 2), from 2006 to 2010 (period 3), and from 2011 to 2015 (period 4). The proportion of patients who received conservative treatment increased from 84.40% in period 2 to 94.74% in period 4, whereas patients who received surgical treatment gradually decreased from 15.60% in period 2 to 5.26% in period 4.

4. Discussion

To the best of our knowledge, the current study represented the largest number of PDLs. In this study, we summarized clinical and pathological features of 1060 cases of PDLs. We further analyzed prognosis of PDLs in comparison with that of PDLs and PSILs. It was found that tumors with younger patients or more follicular lymphoma was significantly higher in PDLs. In addition, PDLs had poorer prognosis compared to PGLs and PSILs. These observations indicate that surgery treatment may not play a role in improving survival in patients as compared to conservative treatment. Since 2000, the proportion of PDL patients undergoing surgery has declined.

We know that follicular lymphoma (FL) is primarily a nodal disease and primary FL of the gastrointestinal (GI) tract is rare [27]. However, the most common histological subtype is FL, followed by DLBCL among of PDLs [22]. Our study showed that the proportion of FL was the highest (44.13%) and significantly higher than that of stomach (2.23%) and small intestine (22.97%). Therefore, the predominance of the follicular histology in PDL was interesting. The high proportion of follicular lymphoma in duodenal lymphoma might be an important reason why the prognosis was better than that of the stomach and small intestine.

Our study showed that the mean age (60.96 [+ or -] 15.205) of patients with PDL was younger than that of the stomach and small intestine, and that the proportion of stage I was also higher than that of the stomach and small intestine. The duodenal anatomy site is special, the tumor growth space is small, and the patient presents the discomfort symptom earlier than the stomach and small intestinal. At the same time, EUS can not only clarify the lesions on the mucosal surface of the gastrointestinal tract but also understand the changes in the hierarchical structure of the gastrointestinal wall and its relationship with adjacent tissues and organs. It might relate to lower age and tumor staging.

Based on the assumption that gastrointestinal tract lymphoma is a localised disease, the surgical treatment was traditionally considered the cornerstone of the therapeutical strategy showing impressive results in terms of long survival. Nowadays, this approach has been extensively revised, and the management of gastrointestinal tract lymphoma is centred on systemic treatments such as chemo- and radiotherapy. From the EER data, the proportion of patients undergoing surgery gradually decreased from 2000 to 2015. From our study, the treatment of PDLs was also in line with the current treatment trend, but interestingly, the proportion of PDLs treated by surgery was lower than that of the stomach (9.64%) and the small intestine (35.13%), among which it was significantly lower than that of the small intestine. The reason maybe that the duodenal lesion is mostly found in the descending segment [4-23], which has a complex anatomical structure and a small possibility of local resection, unlike the small intestine which can be directly resected, so conservative treatment is more preferred. Once a larger operation is performed, it is bound to cause complications and affect the quality of life. Meanwhile, multivariate analysis confirmed that the treatment modality was unrelated to DSS; that is, surgical treatment did not bring a survival advantage. The results were similar to previous reports (Table 4) [28-31] that the survival results of nonsurgical treatment were similar or even better than those of surgical treatment. Surgery, thus, is restricted to the treatment of complications such as occlusion, bleeding or perforation. Preventive surgery is sometimes advocated in bulky tumors, when rapid tumor necrosis secondary to chemo/radiotherapy may be associated with a high risk of life-threatening complications [28]. Surgery is also required for removal of residual disease after medical debulking [32]. Since the SEER database does not list the complications, this paper cannot discuss the complications.

Although there was no statistically significant difference in survival by treatment modalities in the multivariate analysis, there are other multiple factors that contribute to survival. In previous studies, female, low-grade histology and good PS have been reported to be associated with high OS. However, age >60 years, advanced stage, poor performance status (PS), and elevated lactic dehydrogenase (LDH) were associated with poor outcome [3, 32-34]. In our study, age, gender, Ann Arbor staging, and histological type retained independent prognostic factors in the multivariate analysis. Patients with <65 years, female, stage I, and FL were found to be significantly associated with good DSS. LDH and PS are not mentioned in the SEER database, so statistical analysis cannot be made in this paper.

Although it is an excellent resource for comparative outcome analysis for all malignancies involving the gastrointestinal tract, SEER has its limitations. Since the database provides passive follow-up for its registered cases, incomplete data reporting remains a problem. First, much information could not be obtained from the SEER database, such as PS and LDH. Second, the SEER database also did not describe postoperative complications and quality of life score, so we were unable to assess the complications and quality of life associated with surgery.
Abbreviations

CHOP:       cyclophosphamide, doxorubicin, vincristine, and
            prednisolone
COPD:       chronic obstructive pulmonary disease
CVP:        cyclophosphamide, vincristine, and prednisone
D:          died
DLBCL:      diffuse large B-cell lymphoma
DSS:        disease-specific survival
ETCL:       enteropathy-type T-cell lymphoma
F:          female
FL:         follicular lymphoma
JGCA:       Japanese Gastric Cancer Association
L:          live
LDH:        lactic dehydrogenase
M:          male
MALT:       mucosa-associated lymphoid tissue
MCL:        mantle cell lymphoma
NHL:        non-Hodgkin's lymphoma
NR:         no recurrence
PDL:        primary duodenum lymphoma
PGIL:       primary gastrointestinal
PGLs:       primary gastric lymphoma
PS:         performance status
PSILs:      primary small intestinal lymphoma
R:          recurrence
R-          rituximab with CHOP
CHOP:
SEER:       Surveillance, Epidemiology, and End Results


Data Availability

No additional data are available.

https://doi.org/ 10.1155/2020/9327868

Conflicts of Interest

The authors declare that they have no conflicts of interest to this work.

Authors' Contributions

ZGL conceived the study and drafted the manuscript. WY and ZY participated in drafting the manuscript. ZZC designed and supervised the study. All authors contributed to the writing of the manuscript and provided final approval of the manuscript. All authors have read and approved the final version of this manuscript. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Acknowledgments

The authors acknowledge the efforts of the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER database.

References

[1] F. d'Amore, H. Brincker, K. Gronbaek et al., "Non-Hodgkin's lymphoma of the gastrointestinal tract: a population-based analysis of incidence, geographic distribution, clinicopathologic presentation features, and prognosis. Danish Lymphoma Study Group," Journal of Clinical Oncology, vol. 12, no. 8, pp. 1673-1684, 1994.

[2] P. Ghimire, G. Y. Wu, and L. Zhu, "Primary gastrointestinal lymphoma," World Journal of Gastroenterology, vol. 17, no. 6, pp. 697-707, 2011.

[3] S. Nakamura, T. Matsumoto, M. Iida, T. Yao, and M. Tsuneyoshi, "Primary gastrointestinal lymphoma in Japan," Cancer, vol. 97, no. 10, pp. 2462-2473, 2003.

[4] Q.-F. Zheng, J.-Y. Li, L. Qin, H.-M. Wei, L.-Y. Cai, and B. Nong, "Gastrointestinal involvement by mantle cell lymphoma identified by biopsy performed during endoscopy," Medicine, vol. 97, no. 6, p. e9799, 2018.

[5] Y. Linnik, J. Rand, P. Kaur, and X. Liu, "Intravascular large B cell lymphoma diagnosed in random duodenal biopsies. A case report and a literature review," Virchows Archiv, vol. 471, no. 3, pp. 429-431, 2017.

[6] M. Iwamuro, E. Kondo, F. Otsuka et al., "Detection of minute duodenal follicular lymphoma lesions using magnifying endoscopy," Acta Medica Okayama, vol. 70, no. 2, pp. 139-144, 2016.

[7] L. K. Mejia, L. Jiang, and V. Gomez, "A case of ampullary follicular lymphoma," Gastrointestinal Endoscopy, vol. 84, no. 4, pp. 731-732, 2016.

[8] M. Iwamuro, H. Okada, K. Takata et al., "Magnifying endoscopic observation of duodenal involvement of follicular lymphoma before and after chemotherapy," Internal Medicine, vol. 54, no. 14, pp. 1741-1745, 2015.

[9] P. Trivedi, A. Gupta, and S. Pasricha, "Primary diffuse large B-cell lymphoma of ampulla of vater: a rare case report," Journal of Gastrointestinal Cancer, vol. 43, no. 2, pp. 340-343, 2012.

[10] A. Tari, Y. Sato, H. Asaoku et al., "A duodenal follicular lymphoma associated with the lesion mimicking MALT lymphoma in terminal ileum and Bauhin valve," Medical Molecular Morphology, vol. 43, no. 3, pp. 174-177, 2010.

[11] Z. Du, J. Chen, X. Zhou, T. Zhang, B. Chen, and F. Tang, "Composite lymphoma with relapse of enteropathy-type T-cell lymphoma," Leukemia & Lymphoma, vol. 50, no. 5, pp. 749-756, 2009.

[12] S. Cho, K. Ryu, C. Kim et al., "Duodenal mucosa-associated lymphoid tissue lymphoma masquerading as an ulcer scar," Endoscopy, vol. 40, no. 2, p. E175, 2008.

[13] N. Kondo, H. Furuya, S. Yamamoto, A. Nakano, and Y. Sakashita, "Diffuse large B-cell lymphoma in the ampulla of vater causing obstructive jaundice: report of a case," Surgery Today, vol. 38, no. 1, pp. 76-80, 2008.

[14] H. Nakase, M. Matsuura, S. Mikami, and T. Chiba, "Magnified endoscopic view of primary follicular lymphoma at the duodenal papilla," Internal Medicine, vol. 46, no. 3, pp. 141-142, 2007.

[15] P. Born, M. Vieth, and M. Stolte, "Follicular lymphoma of the duodenum," Endoscopy, vol. 39, no. S 1, p. E39, 2007.

[16] K. H. Woo, J. H. Kim, S. B. Yoon et al., "Duodenal mucosa-associated lymphoid tissue lymphoma: a case report," The Korean Journal of Internal Medicine, vol. 22, no. 4, pp. 296-299, 2007.

Canadian Journal of Gastroenterology and Hepatology

[17] C. S. Chim, W. K. Yuen, F. Loong, W. H. Hu, and G. C. Ooi, "Primary large B-cell lymphoma of the ampulla of vater," Haematologica, vol. 91, no. 91, p. ECR06, 2006.

[18] F. I. Jabr, "Large B-cell lymphoma of the duodenal papilla presenting as pneumobilia," Gastrointestinal Endoscopy, vol. 64, no. 4, pp. 669-670, 2006.

[19] T. Zenda, T. Masunaga, B. Fuwa et al., "Small follicular lymphoma arising near the ampulla of Vater: a distinct subtype of duodenal lymphoma?," International Journal of Gastrointestinal Cancer, vol. 36, no. 2, pp. 113-120, 2005.

[20] N. Yildirim, B. Oksiizoglu, B. Budakoglu et al., "Primary duodenal diffuse large cell non-hodgkin lymphoma with involvement of ampulla of Vater: report of 3 cases," Hematology, vol. 10, no. 5, pp. 371-374, 2005.

[21] H. Isomoto, S. Kamihira, E. Matsuo et al., "A case of mucosa-associated lymphoid tissue lymphoma of the ampulla of Vater," European Journal of Gastroenterology & Hepatology, vol. 15, no. 9, pp. 1037-1041, 2003.

[22] E. Nadal, A. Martinez, M. Jimenez et al., "Primary follicular lymphoma arising in the ampulla of Vater," Annals of Hematology, vol. 81, no. 4, pp. 228-231, 2002.

[23] M. Ventrucci, F. Gherlinzoni, E. Sabattini, A. Cipolla, G. M. Ubalducci, and S. Pileri, "Primary MALT-lymphoma of the papilla of Vater," Digestive Diseases and Sciences, vol. 43, no. 1, pp. 214-216, 1998.

[24] N. Howlader, L. A. G. Ries, A. B. Mariotto, M. E. Reichman, J. Ruhl, and K. A. Cronin, "Improved estimates of cancer-specific survival rates from population-based data," JNCI: Journal of the National Cancer Institute, vol. 102, no. 20, pp. 1584-1598, 2010.

[25] H. Zhou, Y. Huang, Z. Qiu et al., "Impact of prior cancer history on the overall survival of patients newly diagnosed with cancer: a pan-cancer analysis of the SEER database," International Journal of Cancer, vol. 143, no. 7, pp. 1569-1577, 2018.

[26] W. R. Shaikh, M. A. Weinstock, A. C. Halpern, S. A. Oliveria, A. C. Geller, and S. W. Dusza, "The characterization and potential impact of melanoma cases with unknown thickness in the United States' surveillance, epidemiology, and end results program, 1989-2008," Cancer Epidemiology, vol. 37, no. 1, pp. 64-70, 2013.

[27] D. P. LeBrun, O. W. Kamel, M. L. Cleary, R. F. Dorfman, and R. A. Warnke, "Follicular lymphomas of the gastrointestinal tract. Pathologic features in 31 cases and bcl-2 oncogenic protein expression," The American Journal of Pathology, vol. 140, no. 6, pp. 1327-1335, 1992.

[28] A. Aviles, M. J. Nambo, N. Neri et al., "The role of surgery in primary gastric lymphoma: results of a controlled clinical trial," Annals of Surgery, vol. 240, no. 1, pp. 44-50, 2004.

[29] F. Selcukbiricik, D. Tural, O. Elicin et al., "Primary gastric lymphoma: conservative treatment modality is not inferior to surgery for early-stage disease," ISRN Oncology, vol. 2012, Article ID 951816, 6 pages, 2012.

[30] J. Huang, W. Jiang, R. Xu et al., "Primary gastric non-Hodgkin's lymphoma in Chinese patients: clinical characteristics and prognostic factors," BMC Cancer, vol. 10, no. 1, p. 358, 2010.

[31] A. Aviles, M. J. Nambo, N. Neri, A. Talavera, and S. Cleto, "Mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach: results of a controlled clinical trial," Medical Oncology, vol. 22, no. 1, pp. 057-062, 2005.

[32] S. S. Yoon, D. G. Coit, C. S. Portlock, and M. S. Karpeh, "The diminishing role of surgery in the treatment of gastric lymphoma," Annals of Surgery, vol. 240, no. 1, pp. 28-37, 2004.

[33] P. Koch, F. del Valle, W. E. Berdel et al., "Primary gastrointestinal non-Hodgkin's lymphoma: I. Anatomic and histologic distribution, clinical features, and survival data of 371 patients registered in the German multicenter study GIT NHL 01/92," Journal of Clinical Oncology, vol. 19, no. 18, pp. 3861-3873, 2001.

[34] P. Koch, F. del Valle, W. E. Berdel et al., "Primary gastrointestinal non-hodgkin's lymphoma: II. Combined surgical and conservative or conservative management only in localized gastric lymphoma-results of the prospective German Multicenter Study GIT NHL 01/92," Journal of Clinical Oncology, vol. 19, no. 18, pp. 3874-3883, 2001.

Guoliang Zheng, Yue Wang, Yan Zhao, and Zhichao Zheng [ID]

Department of Gastric Surgery, Cancer Hospital of China Medical University (Liaoning Cancer Hospital and Institute), No. 44 Xiaoheyan Road, Dadong District, Shenyang, Liaoning 110042, China

Correspondence should be addressed to Zhichao Zheng; drzhengzhichao1@163.com

Received 27 June 2019; Accepted 26 December 2019; Published 13 January 2020

Academic Editor: Quirino Lai

Caption: Figure 1: Comparison of DSS among PDLs, PGLs, and PSILs. The results showed that the DSS of PDLs were significantly better than those of PGLs and PSILs (10-year survival rate: 21.24% vs. 20.40%, P = 0.027; 10-year survival rate: 21.24% vs. 16.79%, P = 0.001). PDLs vs. PGLs: P < 0.05; PDLs vs. PSILs: P < 0.05. PGL, primary gastric lymphoma; PSIL, primary small intestinal lymphoma; PDL, primary duodenum lymphoma.

Caption: Figure 2: The stratified analysis according to (a) age, (b) gender, (c) Ann Arbor staging, and (d) histological type in the PDLs. Patients with <65 years, female, stage I, and FL were found to be significantly associated with good DSS. However, patients with [greater than or equal to] 60 years, male, stage IV, and TCL were found to be significantly associated with poor DSS (all P < 0.05).

Caption: Figure 3: Trend of treatment modality (surgery vs. conservative treatment) to PGLs over the 18-year period from 1998 to 2015. The proportion of patients who received conservative treatment increased from 84.40% in period 2 to 94.74% in period 4, whereas patients who received surgical treatment gradually decreased from 15.60% in period 2 to 5.26% in period 4.
Table 1: Demographics and characteristics of PDLs.

Clinicopathologic features          Number of assessable patients (%)

Age (years)
Mean [+ or -] SD                          60.96 [+ or -] 15.205
  [greater than or equal to] 60                578 (54.53)
  <60                                          482 (45.47)
Gender
  Male                                         604 (56.98)
  Female                                       456 (43.02)
Marital status
  Married                                      611 (57.65)
  Unmarried                                    349 (32.92)
  Unknown                                       100 (9.43)
Race
  White                                        878 (82.83)
  Black                                         69 (6.51)
  Others                                        93 (8.77)
  Unknown                                       20 (1.89)
Ann Arbor staging
  I                                            564 (53.21)
  II                                           182 (17.17)
  III                                           40 (3.77)
  IV                                           173 (16.32)
  Unknown                                       101 (9.53)
Symptoms
  A                                            463 (43.68)
  B                                            127 (11.98)
  Unknown                                      470 (44.34)
Histological type
  DBCLC                                        348 (32.83)
  MALT                                         146 (13.77)
  T-cell                                        28 (2.64)
  FL                                           436 (41.13)
  MCL                                           29 (2.74)
  Unknown                                       73 (6.89)
Combined with other cancers
  Yes                                          111 (10.47)
  No                                           949 (89.53)
Treatment modality
  Only surgery                                  41 (3.87)
  Surgery + conservative                        51 (4.81)
  Conservative                                 968 (91.32)

DLBCL = diffuse large B-cell lymphoma; ETCL = T-cell lymphoma;
FL = follicular lymphoma; MALT = mucosa-associated lymphoid tissue;
MCL = mantle cell lymphoma.

Table 2: Comparison of clinicopathological parameters among PSLs,
PGLs, and PSILs.

Clinicopathologic                       PDLs
features                              n = 1060

Age (years)
  Mean [+ or -] SD              60.96 [+ or -] 15.205
  [greater than or                   578 (54.53)
    equal to] 60
  <60                                482 (45.47)
Gender
  Male                               604 (56.98)
  Female                             456 (43.02)
Ann Arbor staging
  I                                  564 (53.21)
  II                                 182 (17.17)
  III                                 40 (3.77)
  IV                                 173 (16.32)
  Unknown                            101 (9.53)
Symptoms
  A                                  463 (43.68)
  B                                  127 (11.98)
  Unknown                            470 (44.34)
Histological type
  DLBCL                              348 (32.83)
  MALT                               146 (13.77)
  T-cell                              28 (2.64)
  FL                                 436 (41.13)
  MCL                                 29 (2.74)
  Unknown                             73 (6.89)
Treatment modality
  Only surgery                        41 (3.87)
  Surgery + conservative              51 (4.81)
  Conservative                       968 (91.32)

Clinicopathologic                              PGLs
features                              n =10573          P value

Age (years)
  Mean [+ or -] SD              66.08 [+ or -] 14.957   <0.001
  [greater than or                  7205 (68.15)        <0.001
    equal to] 60
  <60                               3368 (31.85)
Gender                                                   0.016
  Male                              5617 (53.13)
  Female                            4956 (46.87)
Ann Arbor staging                                        0.071
  I                                 5616 (53.12)
  II                                1541 (14.58)
  III                                482 (4.56)
  IV                                1731 (16.37)
  Unknown                           1203 (11.37)
Symptoms                                                <0.001
  A                                 3260 (30.83)
  B                                 1313 (12.42)
  Unknown                           6000 (56.75)
Histological type                                       <0.001
  DLBCL                             5168 (48.88)
  MALT                              4323 (40.89)
  T-cell                              78 (0.74)
  FL                                 236 (2.23)
  MCL                                131 (1.24)
  Unknown                            637 (6.02)
Treatment modality                                       0.38
  Only surgery                       401 (3.79)
  Surgery + conservative             619 (5.85)
  Conservative                      9553 (90.36)

Clinicopathologic                               PSILs
features                              n = 3239          P value

Age (years)
  Mean [+ or -] SD              62.41 [+ or -] 16.779    0.013
  [greater than or                  1927 (59.49)         0.004
    equal to] 60
  <60                               1312 (40.51)
Gender                                                   0.065
  Male                              1931 (59.62)
  Female                            1308 (40.38)
Ann Arbor staging                                       <0.001
  I                                 1239 (38.25)
  II                                1047 (32.32)
  III                                143 (4.41)
  IV                                 567 (17.52)
  Unknown                            243 (7.50)
Symptoms                                                <0.001
  A                                 1174 (36.25)
  B                                  432 (13.33)
  Unknown                           1633 (50.42)
Histological type                                       <0.001
  DLBCL                             1778 (54.89)
  MALT                               265 (8.18)
  T-cell                             185 (5.71)
  FL                                 744 (22.97)
  MCL                                 51 (1.57)
  Unknown                            216 (6.68)
Treatment modality                                      <0.001
  Only surgery                       928 (28.65)
  Surgery + conservative            1173 (36.22)
  Conservative                      1138 (35.13)

DLBCL = diffuse large B-cell lymphoma; ETCL = T-cell lymphoma; FL
= follicular lymphoma; MALT = mucosa-associated lymphoid tissue;
MCL = mantle cell lymphoma.

Table 3: Univariate and multivariate analysis for DSS in the PGLs.

Characteristics                       Univariate analysis

                               HR        95% CI      P value

Age (years)                   1.026   1.017-1.035    <0.001
Gender                        0.636   0.491-0.824     0.001
Marital status                1.136   0.950-1.358     0.162
Symptom                       1.239   1.083-1.417     0.002
Ann Arbor staging             1.189   1.099-1.286    <0.001
Histological type             0.696   0.638-0.759    <0.001
Combined with other cancers   0.724   0.483-1.087     0.119
Treatment modality            1.158   0.993-1.349     0.061

Characteristics                       Multivariate analysis

                               HR        95% CI      P value

Age (years)                   1.027   1.018-1.036    <0.001
Gender                        0.633   0.487-0.823     0.001
Marital status
Symptom
Ann Arbor staging             1.202   1.107-1.306    <0.001
Histological type             0.718   0.656-0.786    <0.001
Combined with other cancers
Treatment modality            1.034   0.906-1.182     0.618

Table 4: Previously reported cases of PDLs.

Reference                Num   Age   Sex        Location

Zheng et al. [4]          1    58     M            --
Linnik et al. [5]         1    51     M            --
Iwamuro et al. [6]        2    52     M    Descendant duodenum
                               96     F    Descendant duodenum
Mejia et al. [7]          1    56     M          Papilla
Iwamuro                   1    60     M        Descendant
et al. [8]                                      duodenum
Trivedi et al. [9]        1    36     F     Ampulla of Vater
Tari et al. [10]          1    66     F     Ampulla of Vater
Du et al. [11]            1    65     M    Descendant duodenum
Cho et al. [12]           1    68     M       Duodenal bulb
Kondo et al. [13]         1    78     F     Ampulla of Vater
Nakase et al. [14]        1    57     F          Papilla
Born et al. [15]          1    75     F            --
Woo et al. [16]           1    71     F    Descendant duodenum
Chim et al. [17]          1    73     M     Ampulla of Vater
Jabr [18]                 1    71     F     Ampulla of Vater
Zenda et al. [19]         1    49     F          Papilla
Yildirim et al. [20]      3    33     M     Ampulla of Vater
                               24     M     Ampulla of Vater
                               38     M     Ampulla of Vater
Isomoto et al. [21]       1    46     M     Ampulla of Vater
Nadal et al. [22]         1    55     M     Ampulla of Vater
Ventrucci et al. [23]     1    65     F     Ampulla of Vater

Reference                    Type        Stage

Zheng et al. [4]              MCL        --
Linnik et al. [5]            DLBCL       --
Iwamuro et al. [6]            FL         IV
                              FL         IV
Mejia et al. [7]              FL         --
Iwamuro                       FL         IV
et al. [8]
Trivedi et al. [9]           DLBCL       --
Tari et al. [10]              FL         II2
Du et al. [11]           DLBCL and TCL   --
Cho et al. [12]              MALT        --
Kondo et al. [13]            DLBCL       --
Nakase et al. [14]            FL         I
Born et al. [15]              FL         --
Woo et al. [16]              MALT        EII2
Chim et al. [17]             DLBCL       II1
Jabr [18]                    DLBCL       --
Zenda et al. [19]             FL         I
Yildirim et al. [20]         DLBCL       --
                             DLBCL       --
                             DLBCL       --
Isomoto et al. [21]          MALT        IE
Nadal et al. [22]             FL         --
Ventrucci et al. [23]        MALT        --

Reference                       CD markers           Surgery

Zheng et al. [4]          CD20, CD21, CD5, BCL-2      None
Linnik et al. [5]         CD20, CD45, BCL2, BCL6      None
Iwamuro et al. [6]           CD20, CD10, BCL2          --
                             CD20, CD10, BCL2          --
Mejia et al. [7]         CD-20, CD10, BCL-2, BCL-6    None
Iwamuro                         CD20, CD10,           None
et al. [8]                         BCL2
Trivedi et al. [9]                 CD20                YES
Tari et al. [10]             CD20, CD10, BCL-2        None
Du et al. [11]                CD20, CD3, CD45          YES
Cho et al. [12]                     --                 YES
Kondo et al. [13]        CD20, CD10, CD79a, BCL-2      YES
Nakase et al. [14]              CD10, Bcl-2           None
Born et al. [15]                    --                None
Woo et al. [16]                    CD20               None
Chim et al. [17]                CD20, BCL-6           None
Jabr [18]                 CD20, CD10, CD45, BCL-2     None
Zenda et al. [19]        CD20, CD10, CD79a, BCL-2     None
Yildirim et al. [20]               CD20               None
                                CD20, CD45            None
                                 CD20, LCA            None
Isomoto et al. [21]                BCL-2              None
Nadal et al. [22]               CD10, Bcl-2           None
Ventrucci et al. [23]       CD20, CD79a, BCL-2        None

Reference                Conservation

Zheng et al. [4]             None
Linnik et al. [5]        Chemotherapy
Iwamuro et al. [6]            --
                              --
Mejia et al. [7]              R
Iwamuro                  Bendamustine
et al. [8]                  and R
Trivedi et al. [9]       Chemotherapy
Tari et al. [10]             None
Du et al. [11]              R-CHOP
Cho et al. [12]               --
Kondo et al. [13]           R-CHOP
Nakase et al. [14]           None
Born et al. [15]             None
Woo et al. [16]              CVP
Chim et al. [17]             CHOP
Jabr [18]                Chemotherapy
Zenda et al. [19]           R-CHOP
Yildirim et al. [20]         CHOP
                            CHOEP
                             CHOP
Isomoto et al. [21]       Radiation
Nadal et al. [22]            CHOP
Ventrucci et al. [23]        CVP

Reference                                Follow-up

Zheng et al. [4]                             --
Linnik et al. [5]                         60 mo/L
Iwamuro et al. [6]                           --
                                             --
Mejia et al. [7]                             --
Iwamuro                                      --
et al. [8]
Trivedi et al. [9]                         2 y/L
Tari et al. [10]                             --
Du et al. [11]                            30 mo/R
Cho et al. [12]                              --
Kondo et al. [13]                         19mo/NR
Nakase et al. [14]                        1 mo/NR
Born et al. [15]                             --
Woo et al. [16]                            1 y/NR
Chim et al. [17]                      Died due to COPD
Jabr [18]                                    --
Zenda et al. [19]                            --
Yildirim et al. [20]                       1 y/NR
                         Died due to sepsis and multiorgan failure
                             Died due to suspected perforation
Isomoto et al. [21]                        4 y/NR
Nadal et al. [22]                          2 y/NR
Ventrucci et al. [23]                     15mo/NR
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Title Annotation:Research Article
Author:Zheng, Guoliang; Wang, Yue; Zhao, Yan; Zheng, Zhichao
Publication:Canadian Journal of Gastroenterology and Hepatology
Geographic Code:1U3MI
Date:Jan 1, 2020
Words:5208
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