Diffuse large B-cell lymphoma: Clinical implications of extranodal versus nodal presentation - A population-based study of 1575 cases

Odense University Hospital, Odense, South Denmark, Denmark
British Journal of Haematology (Impact Factor: 4.71). 02/2004; 124(2):151-9. DOI: 10.1046/j.1365-2141.2003.04749.x
Source: PubMed


Differences in genetic origin between nodal and extranodal diffuse large B-cell lymphomas (DLBCL) exist. Using population-based data from the registry of the Danish Lymphoma Group, the present study is the first to analyse clinical implications of nodal versus extranodal presentation of DLBCL. Of 4786 newly diagnosed non-Hodgkin's lymphoma patients in a 16-year period, 1575 (33%) had DLBCL. The annual incidence rate was 2.9 per 100 000; 40% were extranodal. The clinical profile of patients with extranodal DLBCL was different from the nodal DLBCL patients. Extranodal DLBCL was associated with older age and poorer performance score, but also lower tumour burden. In extranodal DLBCL, 51% of the cases were stage I and 36% were stage IV, whereas the patients were relatively equally distributed between the four stages in nodal DLBCL. For stage I patients, extranodal DLBCL was independently associated with poor survival (P = 0.003). In contrast, among stage IV patients those with extranodal DLBCL survived longer (P = 0.009). We conclude that there are important clinical differences between nodal and extranodal DLBCL. The addition of these clinical results to the existing aetiological and genetic data suggests that the distinction between nodal and extranodal DLBCL is not only pathogenetically but also clinically important.

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    • "Extra nodal disease occurs in 40% of the cases being the gastrointestinal tract the most common site [3] . Liver is a common site for metastasis in all types of cancer and some series report that it is compromised in 36% of cancer related deaths. "

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    • "The role of immunochemotherapy in treatment of patients with extra nodal DLBCL was lastly discussed, but data are sparse and controversial. The studies are retrospective in their nature and the largest analyses are based on Asian population [15] [16] [17] [18]. It seems that adding rituximab to chemotherapy does not improve outcomes in patients with extra nodal DLBCL, at least among cases in early clinical stage [36] [37]. "
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    ABSTRACT: Introduction The aim of the study was to assess the prognostic significance of the number and type of extra nodal localizations of DLBCL as well as other factors included in IPI in the rituximab era. Materials and methods We conducted a retrospective analysis of medical documentation of 178 patients with DLBCL treated in two oncology centers between 2006 and 2011. We distinguished 3 subgroups of patients: with only nodal localization of DLBCL (A, n = 80), with 1 extra nodal site (B, n = 66) and with ≥2 extra nodal sites (C, n = 32). Results The presence and the number of extra nodal lesions did not have a prognostic impact both on the response and survival. Probabilities for OS were 79.4% ± 6, 85.5% ± 5 and 78.5% ± 8 for groups A, B and C respectively. Most common extra nodal localizations of DLBCL were: digestive duct, bones and skin. The site of involvement also did not have a prognostic significance. In a multivariate analysis negative prognostic factors for OS probability were: elevated LDH level (HR: 3.12 [95% CI: 1.3-7.47], p = 0.01) and disease stage ≥III (HR: 4.61 [95% CI: 1.32-16.1], p = 0.02). Conclusions Neither the number of extra nodal lesions nor their localization affects prognosis in patients with DLBCL in the rituximab era. © 2015 Polskie Towarzystwo Hematologów i Transfuzjologów, Instytut Hematologii i Transfuzjologii.
    Full-text · Article · Jan 2015 · Acta haematologica Polonica
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    • "Worse outcomes in early-stage DLBCL with extranodal involvement were suggested, while the opposite was reported in advanced stage [6] [8]. Finally, specific extranodal sites of involvement were prognostic in patients with DLBCL in some studies, but not in others, and this issue has not been analyzed in the context of treatment effects [5,9–11]. "
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    ABSTRACT: Using the Surveillance, Epidemiology, and End Results (SEER)–Medicare database, we investigated the relative benefits of adding rituximab to CHOP chemotherapy in diffuse large B-cell lymphoma (DLBCL) of extranodal origin, and found similar advantage for nodal and extranodal lymphomas. Hazard ratio for overall survival was 0.64 for nodal, and 0.70 for extranodal DLBCL. Hazard ratios for lymphoma-related death were 0.62 and 0.57, respectively. The advantage was largest for DLBCL of the spleen, liver and lung. Conversely, it was not evident for thyroid or testicular lymphomas. Compared with nodal DLBCL, spleen was the only site with significantly better prognosis after R-CHOP.
    Full-text · Article · May 2014 · Leukemia research
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