Yeu Chin Chen

The clinicopathological analysis of 303 cases with malignant lymphoma classified according to the World Health Organization classification system in a single institute of Taiwan

Several reports have shown a different distribution of malignant lymphoma (ML) in Asian and Western populations. The purpose of our survey was to elucidate whether there are substantial differences in the frequencies of subtypes of ML between different geographical areas. All entities diagnosed as ML between June 1995 and December 2007 were selected according to the 2008 World Health Organization (WHO) classification and searched for clinical outcomes. The cases were retrieved and reviewed by a panel of clinical haematologists and haematopathologists. A total of 303 patients with ML were identified for retrospective analysis. Of the 303 patients with ML, 278 patients (91.7%) had non-Hodgkin’s lymphoma (NHL), and 25 (9.2%) had Hodgkin’s lymphoma. Of the 278 patients with NHL, 223 (73.6%) had lymphoma of B-cell lineage, and 55 (18.1%) had lymphoma of T-cell lineage. One hundred and thirty-seven patients were diagnosed with diffuse large B-cell lymphoma, which was the most common B-cell lineage subtype and accounted for 45.2% of patients with NHL. Peripheral T-cell lymphomas were the most frequent subset of the T-cell neoplasms, comprising 10.6% of ML. Extranodal involvement was found in 125 (44.9%) of the 278 patients with NHL, and the lymph node was the site of primary involvement in 153 patients (55.1%). Fifty-nine (47.2%) of the 125 patients with extranodal presentation had gastrointestinal tract involvement. Outcome was worse in patients with extranodal NHL than in those with nodal NHL through the entire follow-up period; the difference in survival rates was significant. Our findings clarify the applicability and prognostic relevance of the WHO classification system and provide further information about the incidence of various lymphoma subtypes in Taiwan. Primary extranodal NHL was associated with a worse prognosis and distinct characteristics compared with nodal NHL. The outcome of different types of extranodal NHL should be investigated further.

Non-Hodgkin's Lymphoma of the Stomach: Treatment Outcomes for 57 Patients Over a 20-Year Period

Background: Gastric non‐Hodgkins lymphoma (NHL) is a rare subtype of malignancy, for which no consensus exists about treatment. In this study, the treatment outcomes of gastric NHL in 57 patients were retrospectively evaluated for a period of 20 years at a single institute. Methods: Clinical stages were classified according to the Ann Arbor staging system: 29 patients were stage I, 17 stage II, two stage III, and nine stage IV. The 46 stage I/II patients received aggressive, multimodal therapy: 24 of these (group A) were treated with surgery‐based management, which included surgery alone (n = 6), surgery + chemotherapy (CT; n = 14), surgery + radiotherapy (RT; n = 2), and surgery + CT + RT (n = 2); 22 patients (group B) did not receive surgery, but received CT alone (n = 11), CT + RT (n = 5), or, in patients with low‐grade mucosa‐associated lymphoid tissue (MALT) lymphoma, an oral anti‐Helicobacter pylori regimen (n = 6). The 11 stage III/IV patients received CT and/or RT with regimens similar to those for stage I/II patients. Results: Except for 1 patient with an initial surgical diagnosis, 56 patients underwent gastric endoscopic examination, which proved that 42 had NHL. The rate of diagnostic accuracy by gastroscopy was 75%. After multimodal treatment (n = 46) and a median follow‐up of 54 months (range, 1–210 months), the 5‐year survival rate was 40.3%. The 5‐year survival rates for stage I, II and III/IV patients were 57.2%, 47% and 0%, respectively (p < 0.005). Of the 24 surgical patients (group A) who received sequential CT, with or without RT, 12 remained disease‐free after a median follow‐up of 98 months (range, 1–210 months); 3 patients died because of postoperative complications. Of the 22 non‐surgical patients (group B) who received CT, alone or combined with RT, 14 remained disease‐free after a median follow‐up of 40 months (range, 4–189 months); 1 patient died because of massive gastric hemorrhage after CT. All stage III and IV patients died after a median survival of 4 months (range, 1–8 months). Conclusion: Clinical stage is the most important factor predicting the long‐term survival of patients with gastric NHL. Surgery may still be necessary in cases of failed gastroscopic diagnosis. In early‐stage gastric NHL, non‐surgical treatment seems able to achieve the aims of improved long‐term survival and, in some instances, cure.

Clinicopathological analysis and prognostic factors of 11 patients with primary non-Hodgkin lymphoma of the small intestine in a single institute

The gastrointestinal (GI) tract is the most common extranodal site of involvement in non-Hodgkin lymphoma (NHL). Primary GI NHL is frequently discussed in survival analyses. Primary intestinal NHL is significantly different from primary gastric NHL with regard to its clinical features, pathological subtype, treatment and prognosis. The small intestine is involved in lymphoma less often than the large intestine. The present study aimed to analyze the clinical and pathological characteristics of primary NHL of the small intestine and its prognostic factors. A retrospective analysis was performed on clinical data from 313 cases of NHL that occurred between 1995 and 2008 in the Tri-Service General Hospital (National Defense Medical Center, Taipei, Taiwan). Among these cases, 11 cases of primary NHL of the small intestine were identified. A Cox model was used to perform the multivariate analysis. The Kaplan-Meier method was used for the survival analysis. From the 11 patients with primary NHL of the small intestine, seven patients were male (63.6%) and four patients were female (36.3%). Furthermore, nine patients (81.8%) were diagnosed with B-cell lymphoma, of which five (45.5%) were also diagnosed with diffuse large B-cell lymphoma (DLBL). Abdominal pain and/or distention were present in six (54.5%) of the patients and jejunum involvement was also observed in six (54.5%) of the 11 patients. The mean overall survival (OS) time of the 11 patients was 27.2 months and the four-year survival rate was 36.3%. The mean OS time in the patients with jejunum involvement was shorter than in those without jejunum involvement (16.9 vs. 39.6 months), although this difference was not significant (P=0.657). Surgical treatment was performed on four of the six patients with jejunum involvement due to an acute abdomen or perforation-related peritonitis. The results of the present study indicate that DLBL is the most common subtype of primary lymphoma of the small intestine, and that the site involved in NHL may affect the potential for surgery in patients with intestinal lymphoma. Furthermore, patients with primary lymphoma of the small intestine have been found to have a poor outcome compared with those with lymphoma in other regions of the GI tract. In the present study, a similar trend was observed, however, the sizes of the subgroups of primary lymphoma of the small intestine were too small for individual analysis.

Impact of Interstitial Pneumonia on the Survival and Risk Factors Analysis of Patients with Hematological Malignancy

Background. The emergence of interstitial pneumonia (IP) in patients with hematological malignancy (HM) is becoming a challenging scenario in current practice. However, detailed characterization and investigation of outcomes and risk factors on survival have not been addressed. Methods. We conducted a retrospective study of 42,584 cancer patients covering the period between 1996 and 2008 using the institutional cancer registry system. Among 816 HM patients, 61 patients with IP were recognized. The clinical features, laboratory results, and histological types were studied to determine the impact of IP on survival and identify the profile of prognostic factors. Results. HM patients with IP showed a significant worse survival than those without IP in the 5-year overall survival (P = 0.027). The overall survival showed no significant difference between infectious pneumonia and noninfectious interstitial pneumonia (IIP versus nIIP) (P = 0.323). In a multivariate Cox regression model, leukocyte and platelet count were associated with increased risk of death. Conclusions. The occurrence of IP in HM patients is associated with increased mortality. Of interest, nIIP is a prognostic indicator in patients with lymphoma but not in patients with leukemia. However, aggressive management of IP in patients with HM is strongly advised, and further prospective survey is warranted.