Modified Stage Grouping of Diffuse Large B-Cell Lymphoma Involving the Same Side of the Diaphragm in the Rituximab Era

Hyehyun Jeong; Hyungwoo Cho; Jung Yong Hong; Dae Ho Lee; Shin Kim; Kyoungmin Lee; Eun Hee Kang; Jung Sun Park; Jin Sook Ryu; Jooryung Huh; Cheolwon Suh

doi:10.3389/fonc.2022.888925

Modified Stage Grouping of Diffuse Large B-Cell Lymphoma Involving the Same Side of the Diaphragm in the Rituximab Era

Front Oncol. 2022 May 27:12:888925. doi: 10.3389/fonc.2022.888925. eCollection 2022.

Authors

Affiliations

¹ Lymphoma/Myeloma Program, Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
² Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
³ Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

Abstract

Among patients with diffuse large B-cell lymphoma (DLBCL) involving the same side of the diaphragm, the prognostic implications of extranodal disease or its contiguity with the nodal lesion remain unclear. In this study, patients with DLBCL treated with R-CHOP whose disease was limited to the same side of the diaphragm were included. Survival was assessed by the presence, contiguity, and number of extranodal lesions. Among the 508 patients included, overall survival (OS) and progression-free survival (PFS) did not differ according to the presence of single extranodal involvement or its anatomical contiguity with the nodal lesion. However, patients with ≥2 extranodal involvement showed significantly inferior OS and PFS. We re-classified these patients into two groups: modified stage IIEe (≥2 extranodal involvement, n=92) and modified stage II (nodal or single extranodal involvement irrespective of anatomical contiguity, n=416). This modified staging showed improved prognostic performance based on the time-dependent ROC curve compared with Ann Arbor staging. In conclusion, the survival outcomes of patients with DLBCL on the same side of the diaphragm were associated with the number of extranodal lesions, but not with the contiguity of the lesions or presence of a single extranodal involvement. Based on these results, we propose a modified staging system (modified stage IIEe and II) for these patients.

Keywords: anatomical staging; diffuse large B-cell lymphoma; prognosis; rituximab era; same side of diaphragm.