Clinical characteristics and prognostic analysis of patients with primary intestinal non-Hodgkin lymphoma treated by comprehensive strategies – a retrospective cohort study from a single center in Eastern China

Introduction: Primary intestinal non-Hodgkin lymphoma (PINHL) is a rare extranodal lymphoma with an incidence of only under 2% of all intestinal malignancies and a relatively worse outcome. To discuss the agreement on improving prognosis, we analyzed the clinical data and treatment strategies related to the outcomes of patients with PINHL. Methods: Thirty-seven patients diagnosed with PINHL between September 2012 and February 2022 were retrospectively studied. We collected clinical data and follow-up times for research purposes. Furthermore, we confirmed the critical predicting value of lactic dehydrogenase (LDH) for an important survival index by drawing receiver operating characteristic (ROC) curves. Results: Patients included are those who accepted surgery. The median time of follow-up was 31 months. Prospective overall survival (OS) rates for 1- and 5-years were 64.9% (95% CI: 49.6%–80.2%) and 38.4% (95% CI: 21.9%–54.9%), respectively. Univariate analysis revealed worse prognoses for patients aged ≥ 60 years [ P = 0.005, 95% CI: 5.6%–41.2% (5-year)], those with an ECOG PS score ≥ 2 [ P = 0.008, 95% CI: 6.4%–42.0% (5-year)], and those with LDH levels ≥ 246 U/L [ P = 0.018, 95% CI: 12.0%–65.0%, (1-year)]. Conversely, a better prognosis was observed for patients who underwent surgery combined with chemotherapy [ P = 0.042; 95% CI: 67.1%–98.1% (1-year), 34.1%–76.1%, (5-year)]. Multivariate analysis demonstrated that LDH levels ≥ 246 U/L were an independent risk factor for OS (HR = 3.365, 95% CI: 1.261–8.980, P = 0.015). The predicted critical value of LDH as a prognostic marker, ascertained by ROC curves, was 281.5 U/L [the areas under the curves (AUC) were all > 0.500], with the most significant effect observed for 1-year OS. Conclusions: Surgery plus chemotherapy validly improved OS. As for the terminal cases, chimeric antigen receptor T cell therapy is an important second-line immunotherapy. The prognosis is related to age, PS, LDH value, and whether surgery was combined with chemotherapy, in which an abnormal LDH value was an independent hazard, and the critical predictive value for prognosis was determined.