Epidemiology of primary Extranodal Nonhodgkin lymphoma.

doi:10.21203/rs.3.rs-4277928/v1

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Epidemiology of primary Extranodal Nonhodgkin lymphoma.

https://doi.org/10.21203/rs.3.rs-4277928/v1

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Introduction:

Lymphoma is the seventh most common type of malignant tumor in both sexes, accounting for 5% of cancers. Most non-Hodgkin's lymphomas arise in the lymph nodes or other lymphatic tissues such as the spleen, Waldeyer's ring, and the thymus gland. Localization outside of these sites is called primary extranodal non-Hodgkin's lymphoma, and it constitutes 24-40% of non-Hodgkin's lymphoma. The study aims to determine the prevalence of non-Hodgkin's lymphoma outside the primary nodule and its epidemiology.

Methods:

A cross-sectional study was conducted at Al-Biruni University Hospital in Damascus, Syria from January 2021 to December 2023. All patients with primary extranodal non-Hodgkin's lymphoma admitted to Al-Biruni University Hospital during this period were included in a questionnaire containing all the information. required.

Results:

The total sample was 151 patients, the majority of participants were males (62.3%), the majority were workers, the histological type in most patients 87 patients (57.6%) were DLBCL type, the cell type (84.2%) was at the expense of B cells, The location of the primary tumor was mostly in the stomach (29.1%), and most patients were in the first stage of the disease (50.4%).

Lymphoma is the seventh most common type of malignant tumor in both sexes , accounting for 5% of other cancers . Hodgkin's lymphoma accounts for 15% and is identified on histopathological grounds while all other lymphomas constitute non-Hodgkin's lymphoma. It represents a very heterogeneous group of about forty entities recognized in the latest WHO classification although some types are common. Non-Hodgkin's lymphoma accounts for 3% of cancer deaths annually, mostly at the expense of ages 85-89 (2017-2019). The risk of developing NHL in the United States is approximately 3 times the risk in many different countries and twice the risk in many similar industrialized countries. The annual incidence of non-Hodgkin's lymphoma increased significantly between 1972 and 1995. In the late 1990s, incidence rates stabilized and the mortality rate decreased. Twenty years later, in 2017, the incidence rate reached 18.6 cases per 100,000 people. Non-occupational risk factors that may predispose to non-Hodgkin's lymphoma include:

Age, sex, race, primary or hereditary immunodeficiency syndrome, autoimmune diseases such as Sjögren's disease, celiac disease, rheumatoid arthritis, systemic lupus erythematosus, some types of viruses such as

(HBV -HCV), factors and family history of lymphoma in first-degree relatives. There are some occupational and environmental risk factors that may cause lymphoma such as exposure to chemicals (herbicides), radiation and chemotherapy, and some occupations that increase the risk of non-Hodgkin's lymphoma including: rubber industry, veterinarians, uranium miners, asbestos exposure, Weed industry, metal working, textile workers, farmers, chemists, benzene exposure. Research indicates that smoking increases the risk of developing non-Hodgkin's lymphoma in general, especially the follicular type. Excessive smoking also increases the risk even more, as one study indicates that it may increase the risk of developing non-Hodgkin's lymphoma by 45% and may also affect the effectiveness of treatment. Cancer can reduce the effectiveness of cancer treatment and can lower survival rates. An increased body mass index (BMI) was associated with an increased risk of lymphoma, and a body mass index of more than 30 kg/m2 was associated with twice the risk of developing DLBCL compared to a BMI of 18.5 - 22.9 kg/m2. Approximate information indicates that Up to 23.5% of all DLBCL and 11% of all non-Hodgkin's lymphoma are prevented by avoiding obesity in young adults.

Histologically:

Non-Hodgkin lymphoma occurs when white blood cells known as lymphocytes mutate [9].

These cells include: B cells, T cells, and natural killer cells. About 85% of all non-Hodgkin lymphomas begin in B cells. They may also grow slowly and are called indolent tumors, or they may develop rapidly and are called aggressive tumors. They are divided into:

1. Aggressive B cell non Hodgkin lymphoma subtypes include:

DLBCL
MALT
Lymphoplastic lymphoma
Burkit lymphoma

2. Aggressive T-cell lymphomas and natural killer cell lymphomas include:

PTCL
Angioimmunoblastic T cell lymphoma
Hepatosplenic gamma/delta T cell lymphoma

3. Dormant B-cell tumors

Follicular lymphoma
CLL/ SLL
Marginal zone lymphoma
Waldenstrom (lympho plasmocytic lymphoma)

4. Dormant T-cell tumors

Mycosis fungoid
Sezary syndrome

Study Preparation:

The study is a cross sectional study conducted in Al Bairouny University Hospital concerning all extranodal non Hodgkin lymphoma patients admitted in the hospital from 1/1/2021 to 31/12/2023 who were radiologically and pathologically diagnosed, older than 18 years old, one extranodal or multile extranodal lesions. Approval has been obtained written informed consent of all patients. Ethical approval was obtained from the Institutional Review Board (IRB), College of Medicine, Syrian Private University.

Study tools:

In this study, information was collected from patient records using a form identical to the medical record prepared by the researchers.

Statistical analysis:

In this study, all available data related to extranodal non-Hodgkin's lymphoma were collected, and uploaded twice in a row to increase accuracy and confidence, within the EXCEL program for the purpose of statistical processing and analysis of the data.
Data was Recorded, processed, and classified into groups, tables, and charts that reflect the results of the study well and on scientific foundations using the SPSS program.
Results were compared with the results of international studies.

The total number of the sample was 151 patients. All participating patients were from Syria (100%). The majority of participants were males, 94 (62.3%), while 57 (37.7%) were females.
Regarding the ages of patients at diagnosis, most of the ages ranged between 61 and 70 years, at a rate of 32.6%.
Regarding tumor family history, 131 people had no family history (95%). 6 people had family records (4%), 3 of whom were first-degree relatives
Regarding patients’ medical history, most of them did not have previous diseases (70.2%), and the rest had previous diseases (29.8%). 17% of them had a history of high blood pressure, 6.8% of them had type 2 diabetes, 8.4% of them had a history of heart disease, and 3.5% of them had an ulcer.
Regarding symptoms related to the disease: Most of the patients, 30 patients (20%) suffered from stomach pain since most cases had metastasis to the stomach, 25 patients (16.7%) suffered from swelling of the nodular external site of the site, 22 patients (14.7%) suffered from general fatigue and weakness, and 16 patients (10.7%) of them suffered from neurological symptoms, and all of them had the disease in a neurological setting, including (headache, convulsions, numbness, paresthesias, weakness in the lower extremities, and shortness of breath. 4 patients (2.7%)) suffered from a rash or lesions on the skin. 17 patients (11.3%) and 7 patients with pruritus (4.7%) were all diagnosed with mycosis fungoides, 8 patients with gastrointestinal bleeding (5.3%), and 4 patients with (2.7%) from dysphagia, one patient from vaginal discharge, one patient from jaundice, one patient from early satiety, and one patient from hoarseness (0.7%) for each.
Regarding the histological type, most of the patients (87 patients (57.6%) were DLBCL type, followed by non-Hodgkin lymphoma with undetermined B-cell NHL (28 patients (18.5%)), then MF (11.9 patients). %), followed by MALT lymphoma 8 patients (5.3%), then unspecified marginal lymphoma 4 patients (2.6%), Anaplastic NHL 1 patient (1.3%), and T cell NHL 1 patient (0.7%) .

In general, the incidence rates of primary extranodal non-Hodgkin lymphoma tend to mirror that of other lymphomas, so we make efforts to update the profile of primary extranodal non-Hodgkin lymphoma in our region and focus on the most prevalent individual types.
In our study, most patients were males (62.3%) and females (37.3%). This result is similar to what was found in a study in India, where the percentage was 64% for males and 36% for females.
The largest percentage in our study was almost similar between non-smokers and smokers, with a slight increase at the expense of non-smokers (51.7%) and smokers (48.3%), the majority of whom were men. This is similar to a study in Japan in which the percentage of smokers was (41.7%), mostly at the expense of men ( 62.5%), but this study was for pulmonary localization only.
The majority of patients in our study did not drink alcohol (1.3%), in contrast to international studies, including a British study, in which those who did drink alcohol were (84.7%). This is often due to the difference in customs, traditions, and a conservative religious environment.
Regarding the ages of the patients, most of the ages ranged between (60 and 70), and this is consistent with most studies, including a study in India in which the average age was (61.3 +_ 17.5).
The most common histological type in our study was DLBCL, and its percentage was (57.6%), and this is consistent with most international studies (51%).
The B cell type was prevalent in our study (84.2%), which is consistent with all studies
Regarding the extranodal distribution, the majority was at the stomach (29.1%), and this agrees with most studies
In our study, the LDH marker was high (20.8%), while in the India study the number was more than double that (52%), which may be due to our small sample and omitted data.
In our study, most patients were treated with RCHOP (76%) and then CHOP (5.4%), although CD20 positivity was (86.3%). While in the study conducted in India, CD20 positivity was lower, so most treatment protocols were CHOP.

Ethics approval and consent to participate

This study was approved by the Institutional Review Board (IRB) at Syrian Private University. Written consent was obtained from all participants. Participation in the study was voluntary and participants were assured that there would be no victimization of anyone who did not want to participate or who decided to withdraw after giving consent.

Consent for publication:

Not applicable.

Availability of data and materials:

All data related to this paper’s conclusion are available and stored by the authors. All data are available from the corresponding author on reasonable request.

Competing interests:

None of the authors have any competing interests. The authors alone are responsible for the content and writing of the article. No conflict of interest is declared.

Funding:

This research received no specific grant from SPU or any other funding agency in the public, commercial or non-profit sectors.

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The authors declare no competing interests.

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Epidemiology of primary Extranodal Nonhodgkin lymphoma.

Status:

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Abstract

Introduction

Methods

Results

Discussion

Declarations

References

Additional Declarations

Status:

Version 1