Pancreatic Diffuse Large B-cell Lymphoma in the US Population

Abstract

Background: Pancreatic lymphomas (PLs) represent <2% of all lymphomas and <0.5% of all pancreatic neoplasms. An accurate histologic diagnosis of PL is needed to predict prognosis and adequately treat the patient. This study aims to investigate the demographic, clinical, and pathological factors affecting the prognosis and survival of pancreatic diffuse large B-cell lymphoma (DLBCL). Methods: Demographic and clinical data from 493 cases of DLBCL of the pancreas were identified between 2000 and 2018 using the Surveillance, Epidemiology, and End Results (SEER) database. Results: The most common age group was between the ages of 70 and 79 years (27.0%). While 44% of cases involved distant sites (a proxy for secondary pancreatic DLBCL), regional and localized involvement was seen in 33%, with the most common cause of death being a primary pancreatic DLBCL. Most patients (71%) received only chemotherapy (systemic therapy). The overall five-year observed survival was 46% (95% CI, 43.5-48.3). The one-year and five-year survival with chemotherapy only was 68% (95% CI, 65.3-70.3) and 48% (95% CI, 44.7-50.5), respectively. The one-year and five-year survival with surgery and chemotherapy was 96% (95% CI, 91.3-99.9) and 80% (95% CI, 71.4-89.2), respectively. Surgery with chemotherapy (HR: 0.397 (95% CI, 0.197-0.803), p = 0.010) were both positive predictors in survival prognosis. Multivariable analysis identified age >55 years (HR: 2.475 (95% CI, 1.770-3.461), p < 0.001), distant stage (HR: 6.894 (95% CI, 4.121-11.535), p < 0.001), and undergoing no surgery (HR: 2.610 (95% CI, 1.307-5.215), p = 0.007) as negative predictors for survival. Conclusion: PLs are rare malignant pancreatic neoplasms with DLBCL being the most common histological subtype. An accurate and timely diagnosis of pancreatic DLBCL is necessary to implement effective treatments and reduce mortality. Systemic therapy (chemotherapy) with or without surgical therapy improved survival. Increased age and regional and distant spread negatively impacted survival.

Acute Pancreatitis Revealing a Diagnosis of Diffuse Large B-Cell Lymphoma

“…In prior reports of patients with DLBCL affecting the pancreas, the average age of presentation was typically in their 50s or 60s, rather than in their 20s as seen in our patient. [10][11][12] Our case affirms the recommendation to pursue further testing in acute pancreatitis patients without a clear etiology. In our patient, ultrasound suggested gallstones pancreatitis as a cause (gallstones and sludge in the gallbladder) with a hypoechoic lesion, and if subsequent MRI was not performed, this could potentially have led to delay in diagnosis.…”

“…In prior reports of patients with DLBCL affecting the pancreas, the average age of presentation was typically in their 50s or 60s, rather than in their 20s as seen in our patient. 10–12…”

Pancreatic diffuse large B-cell lymphoma: a case report and literature review

“…PPL, a lymphoma localized to the pancreas with or without peripancreatic nodal involvement, is a rare disease. Older patients and patients with stage IV disease or an aggressive PPL subtype have a worse prognosis (5).…”

“…These treatments are generally administered in six courses. The second-line rituximab, isocyclophosphamide, carboplatin, and etoposide regimen or the rituximab, dexamethasone, high-dose cytarabine, and cisplatin (5) regimen can improve the prognosis of patients with refractory pancreatic DLBCL (4,5). Due to the large size of the tumor and the high risk of postoperative pancreatic fistula, surgical intervention is not the main treatment option for PPL (13).…”

Lymphoproliferative disease: could they be localized in the pancreas?

“…В исследовании A. Ullah и соавт. [17] проанализированы демографические и клинические данные лечения 493 пациентов с ПЛПЖ в период с 2000 по 2018 г. с использованием базы данных (SEER) США. Хирургическая резекция опухоли выполнена 40 (8,1%) пациентам.…”