PRIMARY PANCREATIC LYMPHOMA: CLINICAL PRESENTATION, DIAGNOSIS, TREATMENT AND OUTCOME IN A MULTICENTRIC ITALIAN EXPERIENCE
Notice bibliographique
Résumé
Introduction: Primary Pancreatic Lymphoma (PPL) is a very rare disease, representing only 0.1% of lymphomas and 0.2% of pancreatic tumors. PPL presentation is variable and may overlap the onset of other neoplastic or inflammatory pancreatic diseases, often resulting in diagnostic difficulties. Due to the limited number of PPL study series, standardized diagnostic and therapeutic protocols are currently lacking. Methods: Diagnostic criteria for PPL were established according to the “Fourth WHO Classification of digestive tumors”. Clinical and treatment data of patients diagnosed with PPL between 2005 and 2018 were retrieved from medical record databases of 7 Italian Hematology Units. Overall survival (OS) and progression free survival (PFS) were calculated according the Kaplan Meier test and compared by the log-rank test. Results: Overall 37 patients were affected by PPL. Clinical manifestations at diagnosis are summarized in the table. Most patients (83%) had a high grade B cell histotype. Fifty nine % of patients were first line treated with chemotherapy, 21% with chemo + radiotherapy, 10% with surgery + chemotherapy, 3% with surgery and 7% did not received any treatment. With a median follow up of 37.5 months the 2 year OS is 59% while the 2 year PFS is 45%. Provided the relatively low number of cases, patients with low grade lymphomas and a good risk Revised International Prognostic Index (R-IPI) had better median OS (not reached vs 26 months and not reached vs 8 months, p=0.31 and 0.001) and PFS (not reached vs 108 months and 108 vs 8 months, p=0.095 and 0.01) as compared to the others. There were no differences in OS and PFS beetween chemotherapy or chemo-radiotherapy treatments (p=0.8 and 0.33) while patients who underwent debulking surgery (alone or + chemotherapy) had a significant worse OS as compared to those treated with chemotherapy alone (median not reached vs 6 months, p=0.033). Importantly 3/28 (10.7%) patients with high grade PPL experienced a central nervous system (CNS) relapse of disease. Conclusions: PPL represents a rare and difficult-to-recognize disease with symptoms and pancreatic gland localization superimposable to those of pancreatic ductal adenocarcinoma. Most PPL are high grade non Hodgkin lymphoma. According to our study biopsy should be the preferred diagnostic method since debulking surgery was associated with a worse OS. The high CNS relapse rate suggests that patients with high grade PPL should receive CNS directed prophylaxis. Keywords: extranodal lymphomas.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».