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Adult primary testicular lymphoma: clinical features and survival in a series of patients treated at a high-volume institution in China

  • De-Hong Caoone,ii  na1,
  • Li Laione,
  • Jian-Bing Guo1,2,
  • Ze-Yu Chen1,2,
  • Yin Huang1,2,
  • Shi Qiu1,2,
  • Tian-Hai Lin1,2,
  • Yue Gou3,
  • Na Ma4,
  • Lu Yang1,2,
  • Liang-Ren Liu ORCID: orcid.org/0000-0001-7597-6241 1,2 &
  • Qiang Wei1,two

BMC Cancer book 20, Article number:220 (2020) Cite this article

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Abstract

Groundwork

To retrospectively investigate the clinical characteristics, initial handling, relapse, therapy outcome, and prognosis of Chinese patients with primary testicular lymphoma (PTL) through analysis of the cases of our constitute.

Methods

From Dec 2008 to July 2018, all patients with PTL were included in this study. Kaplan-Meier method was used to estimate PFS and Bone. The Cox proportional hazards model was used to compare the survival times for groups of patients differing in terms of clinical and laboratory parameters.

Results

All 28 PTL patients (24 DLBCL, three NK/T lymphomas, and 1 Burkkit's lymphoma) with a median age of 65.5 years were included in this study. 6 patients were observed recurrence amidst all the 22 individuals evaluated. Following orchiectomy and systemic chemotherapy, with or without intrathecal prophylaxis, consummate response was achieved in 15 (68%) patients. For DLBCL patients, the median progression-complimentary survival (PFS) was 44.63 months (95% CI 17.71–71.56 months), and the median overall survival (Bone) was 77.02 months (95% CI, 57.35–96.69 months). For all the DLBCL patients, the v-year PFS and 5-year OS were 35.4% (95%CI, fourteen.8–56.0%) and 53.four% (95%CI, 30.1–76.7%). Without further chemotherapy following orchiectomy (HR = 3.4, P = 0.03) were associated with junior PFS of DLBCL patients. Advanced Ann Arbor stage (Hr =five.nine, P = 0.009) and high (international prognostic alphabetize, IPI) score: 3–5 (60 minutes =3.9, P = 0.04) were correlated with shorter Os of DLBCL patients.

Conclusion

This written report confirms that PTL is an ambitious malignant with a poor prognosis. Express Ann Arbor stage, further chemotherapy following orchiectomy, and low IPI score (less than ii) are correlated with superior survival for DLBCL patients.

Peer Review reports

Introduction

Primary testicular lymphoma (PTL) is a rare entity with an almanac incidence of 0.26 cases per 100,000 person-years and the almost common cancerous testicular neoplasms in male over 60 years erstwhile, which accounts for virtually i–9% in testicular tumors and 1–2% of all non-Hodgkin'south lymphomas [i,two,3]. The diagnosis of primary testicular lymphoma is usually confirmed through orchiectomy or testis biopsy. Diffuse big B-cell lymphoma (DLBCL) is nearly common histological subtype of primary testicular lymphoma, comprising eighty–xc% of all primary lymphoma of testis [ane, four,5,6]. The most common clinical symptom of PTL is a unilateral painless testicular swelling developing more than weeks to months, even several years. In improver, a minority of patients appear a testicular swelling with precipitous pain. Furthermore, bilateral testicular swelling is seen in around 35% of patients [3, 7, 8].

PTL is an extremely ambitious cancerous with poor progression-costless survival (PFS) and overall survival (OS). PTL performs an inclination to involves the contralateral testis and the cardinal nervous organization (CNS), and disseminate to other extranodal sites such as skin, lung, kidney, adrenal, gastrointestinal, and other soft organs [1, 8,ix,10]. A phase ii study revealed that the v-year PFS and Bone rates were 74 and 85% among limited stage chief testicular DLBCL individuals who received anthracycline-containing chemotherapy in combination with rituximab, prophylactic contralateral scrotal radiotherapy and CNS prophylaxis with intrathecal (IT) chemotherapy [11]. Nevertheless, at that place are fewer studies providing information for advanced stage PTL patients regarding the survival and outcomes. Recently, several retrospective studies demonstrated improved survival in DLBCL of testis with the addition of rituximab [8, 12]. However, survival improvement has non been observed in other analyses [two]. However, several studies revealed that the addition of rituximab to CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy results in meaning subtract of CNS relapse in PTL [xiii,14,15].

The aim of the nowadays work was to retrospectively investigate the clinical characteristics and therapy effect of Chinese patients diagnosed with PTL through analysis of the cases of our institute.

Methods

Patients were identified by searching database of West China Hospital of Sichuan University for cases of testicular lymphoma occurring from Dec 2008 to July 2018. 28 patients with master PTL were included in this study. The inclusion criteria were signs or symptoms of a testicular mass at presentation, diagnosis of PTL by orchiectomy or needle biopsy, historic period over 18 years erstwhile, and without the history of lymphoma therapy. Moreover, patients who were initially diagnosed with lymphoma exterior the testis and who developed a secondary testicular lymphoma were excluded from this report. Therefore, patients with secondary testis involvement were excluded. In improver, all the PTL patients were verified by immunohistochemistry staining. All bachelor clinical files were collected and data apropos age, B symptoms, body mass index (BMI), laterality, tumor size, serum lactate dehydrogenase (LDH), serum β-human being chorionic gonadotropin (HCG), serum alpha fetoprotein (AFP), pathology classification, eastern cooperative oncology grouping (ECOG) score, international prognostic index (IPI), Ann Arbor stage initial handling, response to treatment, site and time of relapse, and status at final follow-up were recorded. At the same time, because of the limitation of retrospective written report, not all variables were available for every individual. Therefore, missing serum LDH was considered to exist 0 points when computing IPI. And so, Co-ordinate to the criteria of our institution: serum LDH ≥220 IU/L, serum β-HCG ≥3.81 mIU/ml,serum AFP ≥8 ng/ml were considered to be elevated.

According to the Ann Arbor criteria, the clinical stage was adamant on the footing of medical history, concrete examination, blood routine examination, liver and renal function tests, B-ultrasonography, computed tomography, and bone marrow biopsy. StageIindicates that the cancer has mono or bilateral testicular interest only. StageIIindicates that the tumor with mono or bilateral of the testis involvement is associated with concomitant involvement of loco-regional (peritoneal and/or iliac) lymph nodes. Phase IIIorIV is defined by mono or bilateral testicular interest with involvement of afar lymph nodes and/or extranodal sites [sixteen]. In addition, B symptoms are defined equally a recurrent fever of >38 °C, nighttime sweets, and weight loss >ten% within 6 months before diagnosis.

Treatment response of patients is classified according to the definitions recommended by the International Workshop to Standardize Response Criteria for Non-Hodgkin'southward Lymphomas [17]. Complete remission (CR) was divers equally the disappearance of all detectable clinical and radiographic testify of disease and disappearance of all disease-related symptoms nowadays before therapy. Partial remission (PR) was defined as a ≥ fifty% reduction in tumor majority. Stable illness (SD) was defined every bit less than a partial remission but non progressive illness. Progressive disease (PD) was defined as a ≥ 50% increase in the sum production of the greatest diameters of any previously identified abnormal tumor majority or the appearance of whatever new signs of affliction during or at the end of therapy. Overall survival (OS) was measured from the time of diagnosis to the time of expiry from any cause or of final follow-upwardly. Progression-costless survival (PFS) was measured from the time of diagnosis to the time of the disease progression, the affliction relapse, the latest check-upwards, or death from lymphoma. Moreover, Patients treated just by testis biopsy, were considered as existence in PD, who did not receive whatsoever treatment subsequently testis biopsy. So, patients treated only by surgery were considered as being in CR if no signs of disease were noted subsequently orchiectomy.

Kaplan-Meier method was used to estimate PFS and Os. Differences between curves were analyzed by using the log-rank test. The chi-square test was used to detect statistically significant differences for categorical variables. The Cox proportional hazards model was used to compare the survival times for groups of patients differing in terms of clinical and laboratory parameters. Analyses were carried out using SPSS 21.0 software package (Chicago, IL, USA). Reporting of all the analysis is understanding with guidelines for reporting of statistics in European Urology [18].

Results

Clinical characteristics

A summary of the main clinical characteristics of all patients is presented in Table 1. Twenty-viii male patients diagnosed with PTL with a median age of 65.5 years (IQR 56.five–72.eight years) met the eligibility criteria for our study. The most mutual initial symptom of patients was unilateral or bilateral swelling of testis, accompanied by pain in few cases. And then, interestingly, B symptoms were absent in 25 (89%) patients; and three (11%) patients were unknown. The median tumor size is five.0 cm (IQR four.1–7.1 cm). Serum LDH is elevated in fourteen (50%) patients, and unknown in three (11%) patients. In add-on, 8 (29%) patients, 16 (57%) patients and iv (14%) patients had depression (0–1 risk factors), intermediate (2–3 risk factors) or a loftier (4–v risk factors) IPI score, respectively. The Ann Arbor clinical phase was equally follows: phase Iin 14 (50%) patients, phase II in five (eighteen%) patients, stage Three in three (11%) patients, stage IV in 4 (14%) patients, and stage unknown in two (7%) patients. The bulk of advanced stage illness had additional extranodal sites including prostate, urinary bladder, kidney, adrenal gland, lung, heart, and other soft tissues.

Table 1 Clinical characteristics

Full size table

Pathological characteristics

Immunochemistry staining was performed in all 28 patients. 24 out of 28 patients (85%), 3 cases (11%), sole 1 (4%) were confirmed DLBCL, NK/T lymphoma and Burkitt's lymphoma, respectively. Table 2 summarizes immunohistochemistry characteristics patients with PTL. Firstly, All the DLBCL were CD20+. Interestingly, both CD10 and CD3 were negative in 23 patients (96%), and positive in ane patient (4%). On the contrary, 23 cases (96%) out of 24 DLBCL were Mum-1+ and 1 tumor (4%) was Mum-1-. In addition, it is like to Mum-1 that bcl-6 was weakly positive in two patients. Median of Ki-67 expression in DLBCL and PTL is eighty% (IQR 61.3–88.8% in DLBCL).

Table 2 Results of immunohistochemistry staining of all patients with chief testicular lymphoma

Full size table

The immunohistochemistry of NK/T lymphoma and Buekkit's lymphoma was not presented in Table two because of few patients. Moreover, other markers such equally granzyme B, CD30, PLAP, CD79a were not performed in Table two considering these markers were non reported past pathologists.

Initial treatment

An overview of the main clinical information, treatment modalities, and outcomes is presented in Table 3. Twenty-six patients (93%) underwent orchiectomy, including four patients with bilateral orchiectomy and 22 patients with unilateral orchiectomy, as first therapeutic and diagnostic intervention. Two patients (vii%) received testis biopsy to confirm diagnosis. In our written report, there are eight patients without farther treatment.

Table 3 Patients treatment and outcomes

Full size table

Prophylactic radiotherapy (RT) to the contralateral testis was given to v patients, and i patient had additional radiation to the involved lymph node areas.

In total, twelve patients (43%) out of 28 patients were administrated with systemic chemotherapy later on orchiectomy. 1 patient (4%) received CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy, and nine patients (32%) received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone), and two patients (7%) received R-CHOP plus CHOP chemotherapy. Besides systemic chemotherapy, in eight patients (29%), intrathecal prophylaxis (It) was delivered with 15 mg methotrexate (MTX) plus 5 mg dexamethasone or 50 mg cytarabine plus 5 mg dexamethasone or xv mg MTX plus 30 mg cytarabine plus five mg dexamethasone.

Therefore, only five patients received combined modality therapy of systemic chemotherapy, RT, and It.

Outcome

Above all, at a median follow-up time of 74.29 months (IQR 34.36–84.81 months), six patients (21%) were lost to follow-upwardly. Thus, twenty-two patients out of 28 patients were evaluable for initial therapy response. CR was achieved in 15 (68%) patients, including fourteen limited stage patients (stageIor Ii) and only one advanced phase patient (Iii or IV). In improver, PR was observed in one (v%) phase Ii patient and SD was recognized in ane (5%) stage III patient. Furthermore, PD was detected in five patients (23%). It'southward worth noting that all patients with disease progression are advanced stage and four patients out of five patients didn't receive further handling after orchiectomy.

The Kaplan-Meier estimated median PFS of all the DLBCL patients was 44.63 months (95% CI 17.71–71.56 months) every bit shown in Fig. 1a, and the median Os was 77.02 months (95% CI 57.35–96.69 months) as shown in Fig. 1b. For all the DLBCL patients, the 5-year PFS and 5-year Os were 35.4% (95%CI, 14.8–56.0%) and 53.4% (95%CI, xxx.1–76.7%).

Fig. ane
figure 1

Kaplan-Meier survival curves showing (a) progression-gratis survival (PFS) and (b) overall survival (Bone) of DLBCL patients

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Relapse

In the 22 patients who nosotros could evaluate, 6 (27%) had relapsed, with a median time to relapse of 33.25 months (range: ii.40–70.24 months). The extranodal sites were every bit follows: CNS, contralateral testis, soft tissue, right neck, maxillary sinus. In the eight patients treated with intrathecal chemotherapy, 2 (25%) patients relapsed in the CNS. Furthermore, two patients with CNS relapse received It, which was administered concurrently with systemic chemotherapy. The IT regimens of the starting time patient with CNS relapse were 15 mg MTX plus 5 mg dexamethasone for one time and l mg cytarabine plus 5 mg dexamethasone for twice. So, the IT regimen of another patient with CNS relapse was 15 mg MTX plus 30 mg cytarabine plus five mg dexamethasone for three times. While in those not treated with intrathecal chemotherapy, nobody had a relapse of CNS. Furthermore, we recognized that one patient, who was administrated with prophylactic radiotherapy only without chemotherapy, had relapsed in the contralateral testis. In addition, 2 patients with relapse didn't receive whatsoever therapy afterward orchiectomy. Then, one patient with relapse was treated with systemic chemotherapy, RT, and IT.

In our series, among the six individuals with relapsed disease, five patients received the second line chemotherapies. Two cases were administrated with R-MA (rituximab, methotrexate and cytarabine), and iii patients received R-Ice (rituximab, ifosfamide, carboplatin and etoposide), and a unmarried patient did not receive any farther therapy at disease relapse. Moreover, CR was achieved in three patients (one received R-MA and two received R-ICE). PD was observed in three cases (i received R-MA, one received R-Water ice and one without further therapy). Regrettably, none of the patients underwent stalk cell transplantation (SCT) in our serial.

Finally, in patients with known relapse, patients who had received R-CHOP based treatment relapsed at 38.77, 71.2, 54.23 months, respectively. In contrast, other patients relapsed at 12.77, 8.6, 2.6 months respectively. This marked difference demonstrated that standard chemotherapy is strongly encouraged fifty-fifty though information technology may not be curative for about patients.

Prognostic factors for DLBCL

Ann Arbor stage and IPI score were associated with Bone. The five-year OS was 66.0% in patients with stageIor II versus 25.0% in patients with stage III or 4 (Log-rank P = 0.0009). The median Bone time of patients with stage 3 or IV was 27.24 months (95%CI, 2.84–51.64 months), as shown in Fig. 2. In our written report, IPI score was significantly associated with patients Os. The v-year OS was 69.6% in patients with IPI score 0–2 versus 21.nine% in patients with high IPI score 3–5 (Log-rank P = 0.04). The median OS fourth dimension of patients with high IPI score iii–five was 28.00 months (95%CI, 12.78–43.23 months), as shown in Fig. 3.

Fig. 2
figure 2

Kaplan-Meier survival curves showing overall survival (Os) of DLBCL patients by Ann Arbor phase

Total size image

Fig. 3
figure 3

Kaplan-Meier survival curves showing overall survival (OS) of DLBCL patients past international prognostic index (IPI) score

Full size prototype

A Cox proportional hazards model including Ann Abor stage, serum LDH, IPI score, ECOG score, location, age, further chemotherapy, further radiations, intrathecal prophylaxis and tumor size was constructed. In the univariable cox hazard ratio model, analysis of factors influencing PFS and Bone of DLBCL patients is summarized in Table 4. Without commencement line chemotherapy following orchiectomy (HR = 3.4, P = 0.03) was associated with a significantly shorter PFS. Factors associated with a significantly shorter OS included advanced Ann Arbor stage disease (Hr =5.ix, P = 0.009), high IPI score: 3–5 (Hour =3.9, P = 0.04).

Table 4 Univariable cox proportional take a chance model for independent effects of Ann Abor stage, serum LDH, IPI score, ECOG score, location, historic period, further chemotherapy, further radiations, intrathecal prophylaxis, and tumor size on progression-free survival (PFS) and overall survival (OS)

Full size table

Due to the fact that "further chemotherapy following orchiectomy" was the unique variable associated with PFS significantly in univariable cox hazard ratio analysis, nosotros didn't perform a multivariable model in terms of PFS. With regard to OS, then, we create a multivariable model including the following variables: stage and IPI score. We notice that high IPI score: 3–5 was associated with a marked inferior Bone (60 minutes = five.3, 95%CI i.4–19.7, P = 0.01).

Give-and-take

Our report confirms that main testicular lymphoma (PTL) is a rare malignant with poor prognosis. The median age of presentation in our report (65.5 years) was on par with other studies [1, three, 19], which reported that PTL is most common in male person over threescore years. It is worth noting that the OS of patients with testicular lymphoma had gradually improved over the by decades. In the early years, the treatment of PTL included orchiectomy, followed chemotherapy and radiation. Until to 1995, a combined modality therapy was recommended to PTL, which consists of orchiectomy, systemic chemotherapy, scrotal radiotherapy, and prophylaxis intrathecal chemotherapy [20]. Information technology is extensive understanding that orchiectomy is the main diagnostic approach and first therapy in PTL. Therefore, survival improvement of PTL possibly was contributed to doxorubicin based chemotherapy (CHOP, R-CHOP), scrotal radiotherapy, and prophylaxis intrathecal. Moreover, it was also shown to exist true in our study that a combined modality therapy could promote PTL patients survival.

Patients with PTL have a 10–15% increment in survival because of the incorporation of rituximab into standard therapy with CHOP with minimal added toxicity. The benefit of rituximab for DLBCL has been provided in patients with limited stage illness [21, 22] and avant-garde stage disease [23,24,25]. In 2017, Robert Kridel et al. [10] demonstrated that rituximab was associated with significantly improved PFS, Os and cumulative incidence of testicular lymphoma progression, which is agreement with observation results in nodal DLBCL [21, 23, 25]. In our study, nosotros didn't compare R-CHOP group with CHOP grouping because of small-scale size sample and only ii patients receiving pure CHOP. Still, nosotros found that patients received further chemotherapy or not was significantly associated with outcome.

The role of Information technology chemotherapy equally CNS prophylaxis is nevertheless a matter of debate. Zouhair et al. [26] noted that CNS relapse fraction in patients received IT prophylaxis is aforementioned to those who didn't receive Information technology prophylaxis. Furthermore, Zucca et al. [one] carried out a report which demonstrated improved PFS among a small subset of patients administrated with IT prophylaxis but non a statistically significant reduction in the CNS relapse rate. Then, in the viii patients treated with intrathecal chemotherapy, two (25%) patients relapsed in the CNS. While in those not treated with intrathecal chemotherapy, nobody had a relapse of CNS. Thus, CNS prophylaxis with IT in our institute was failure based on this experience. Nevertheless, the failure experience does non entirely propose IT is non useful, as the intensity of Information technology may non be adequate in these patients. Therefore, further studies are needed to explore adequate intensity of CNS prophylaxis IT. Furthermore, a statistically meaning improvement was not recognized in patients treated with prophylactic intrathecal methotrexate or cytarabine in our study. One of potential reasons is that our study sample was as well small-scale to larn statistically pregnant result. Another reason contributes to this event might be that intrathecal prophylaxis distinctly could not ameliorate PFS and Bone. In improver, possibly the tertiary one reason was that simply advanced Ann Arbor stage patients treated with IT prophylaxis rather than limited Ann Arbor phase patients.

Of interest, it is worth noting that one patient occurred relapse of contralateral testis inside two months who only received radiation afterward orchiectomy. Furthermore, a significantly decreased contralateral testis relapse rate in patients with prophylaxis radiotherapy was non indicated in our study maybe considering of small sample. Nevertheless, the benefit of safety radiation to reduce the adventure of contralateral testis relapse has been confirmedly demonstrated in some studies [1, 27]. In addition, we accept to accent that a bulk of patients with PTL were over sixty years once again. Therefore, it is not greatly necessary to preserve testicular function so that safe radiation to the contralateral testis should be taken into medico consideration.

A tendency of PTL spreading to extranodal site, including CNS, contralateral testis, lung, kidney, adrenal gland and soft tissues, has been reported in a large number of studies [6, 8, ten, 28, 29]. In our study, the extranodal sites of PTL broadcasting, including CNS, contralateral testis, kidney, adrenal gland, maxillary sinus, and soft tissue, which is in universal agreement with other studies. Even so, the reason for this preferential interest in other extranodal sites remains unknown. Potential explanation including, (i) the efficacy of chemotherapy will exist decreased in CNS and contralateral testis due to the blood encephalon barrier and blood-testis barrier [1]; (two) lacking of expression of integrin and adhesion molecules in PTL resulting in poor adhesion of tumor cells to the extracellular matrix [30, 31]; and (3) CD44 variant plays significant roles in lymphoma dissemination [32].

Information technology has been reported that meliorate PFS and Os were associated with good operation condition, limited stage, low IPI score, absenteeism of B symptoms, normal serum LDH, and β2-microglobulin, absenteeism of boosted extranodal sites involvement, and right testis involvement [i, ii, 8, 28, 29]. Then, we carried out univariate assay in our report and plant that the prognostic factors associated with a poor outcome included avant-garde Ann Arbor stage, without further chemotherapy after orchiectomy, and loftier IPI score, which is universal consistent with other reports [half dozen, 8, 10, 28, 29, 33]. Attributable to extremely rare incidence of NK/T cell lymphoma and Burkitt's lymphoma in testis, to the all-time of our cognition, a majority of study of them are limited to small-scale case series only or case reports [34,35,36,37,38,39]. Nevertheless, Besides DLBCL, NK/T cell lymphoma and Burkitt's lymphoma were taken into our study too.

A meta-assay to investigate high dose chemotherapy plus autologous SCT in the first line therapy of not-Hodgkin'south lymphoma patients manifested that OS showed no pregnant deviation between high dose chemotherapy plus autologous SCT and conventional chemotherapy (HR1.0, 95%CI 0.ix–1.2, P = 0.half-dozen) as well as event gratuitous survival (HR0.9, 95% CI 0.8 to one.1, P = 0.three), and CR rates were significantly higher in the group receiving high dose chemotherapy plus autologous SCT than conventional chemotherapy [40]. Nevertheless, another study demonstrated that loftier dose chemotherapy plus autologous SCT significantly increase result free and Bone compared with conventional chemotherapy in relapsed non-Hodgkin's lymphoma patients [41]. Thus, high dose chemotherapy and autologous SCT are considered for relapsed PTL in view of PTL as a rare affliction with poor prognosis.

We recognize that this retrospective study has potential shortcomings. Firstly, due to the retrospective nature, data of six patients are missing in our study, including further treatment, response to therapy, time to relapse. The rate of lost to follow-upwards (21%) in our study closes to the rate of lost to follow-up accustomed by academia (xx%). Therefore, the results and decision of our study is credible. Secondly, another limitation of our study is that the Kaplan-Meier and Cox proportional hazards model were not performed to analysis the survival and prognostic factors of NK/T lymphoma and Buekkit's lymphoma cases in view of few cases. Therefore, multi-centers, large sample and prospective studies are needed to investigate the survival and prognostic factors of NK/T lymphoma and Buekkit'south lymphoma individuals. However, serum AFP and β-HCG were summarized in our study, which were not reported in other studies about PTL. Moreover, nosotros found that neither serum AFP nor β-HCG was elevated in any patient of our study. Therefore, what practice we desire to demonstrate is that PTL should exist taken into medico's consideration when both serum AFP and serum β-HCG are normal in patients with testis swelling.

Conclusion

This written report confirms that PTL is an aggressive malignant with a poor prognosis. Express Ann Arbor stage, further chemotherapy following orchiectomy, and low IPI score (less than 2) are correlated with superior survival for DLBCL patients. Thus, systemic treatments, including orchiectomy, chemotherapy, radiotherapy, and intrathecal prophylaxis, are necessary for all the patients with PTL.

Availability of data and materials

All data generated or analyzed during the present study are included in this published article. The authors declare that materials described in the manuscript, including all relevant raw information, will exist freely available to any scientist wishing to employ them for non-commercial purposes, without breaching participant confidentiality.

Abbreviations

PTL:

Primary testicular lymphoma

DLBCL:

Diffuse large B-jail cell lymphoma

GCB:

Germinal center B

NK/T:

Natural killer/T

PFS:

Progression free survival

OS:

Overall survival

CNS:

Primal nervous system

IELSG:

Extranodal Lymphoma Study Group

It:

Intrathecal

RT:

Radiotherapy

CHOP:

Cyclophosphamide, doxorubicin, vincristine and prednisone

R-CHOP:

Rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone

R-MA:

Rituximab, methotrexate and cytarabine

R-Ice:

Rituximab, ifosfamide, carboplatin and etoposide

BMI:

Trunk mass index

LDH:

lactate dehydrogenase

HCG:

Human chorionic gonadotropin

AFP:

Alpha fetoprotein

ECOG:

Eastern cooperative oncology group

IPI:

International prognostic alphabetize

CR:

Complete remission

PR:

Partial remission

SD:

Stable disease

PD:

Progressive disease

MTX:

Methotrexate

CI:

Confidence interval

60 minutes:

Take chances ratio

SCT:

Stem cell transplantation

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Acknowledgements

The authors would like to thank Ms. Li-yuan Xiang for giving technical support in statistical analyses.

Funding

The blueprint of this report and analysis of data were supported by the National Natural Science Foundation of Cathay (Grant no. 81770857, 81370855 and 81200551) and Science and Technology Programme of Sichuan Province (Grant no. 2015SZ0230 and 2017KJT0034).

Author information

Author notes

  1. Bo Chen and De-Hong Cao contributed every bit to this work.

Affiliations

  1. Department of Urology, West China Infirmary, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China

    Bo Chen, De-Hong Cao, Li Lai, Jian-Bing Guo, Ze-Yu Chen, Yin Huang, Shi Qiu, Tian-Hai Lin, Lu Yang, Liang-Ren Liu & Qiang Wei

  2. Establishment of Urology, West Communist china Infirmary, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People'south Republic of China

    Bo Chen, De-Hong Cao, Jian-Bing Guo, Ze-Yu Chen, Yin Huang, Shi Qiu, Tian-Hai Lin, Lu Yang, Liang-Ren Liu & Qiang Wei

  3. Department of outpatient, Due west China Infirmary, Sichuan University, Chengdu, 610041, People's republic of china

    Yue Gou

  4. West Cathay School of Medicine, Sichuan University, Chengdu, 610041, Cathay

    Na Ma

Contributions

BC and DC: project development, data collection and management, manuscript writing and revising; L Lai, JG, ZC, SQ, YH, NM, YG, and TL: information collection, data assay; LY, LLiu and QW: project design and evolution, data interpretation, manuscript editing and revising. All authors read and approved the concluding manuscript.

Corresponding authors

Correspondence to Liang-Ren Liu or Qiang Wei.

Ethics declarations

Ethics approval and consent to participate

The protocol of this retrospective report, involving individuals' clinical information collection, was canonical and the need for informed consent was waived by the Ethics Commission of West Cathay Hospital of Sichuan University.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Chen, B., Cao, DH., Lai, L. et al. Adult chief testicular lymphoma: clinical features and survival in a series of patients treated at a high-volume establishment in China. BMC Cancer 20, 220 (2020). https://doi.org/x.1186/s12885-020-6711-0

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  • DOI : https://doi.org/ten.1186/s12885-020-6711-0

Keywords

  • Principal testicular lymphoma
  • Diffuse big B-jail cell lymphoma
  • Testis

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Source: https://bmccancer.biomedcentral.com/articles/10.1186/s12885-020-6711-0

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