Primary diffuse large B-cell lymphoma of the breast: A retrospective study of outcomes and insulin resistance

Weiling Zhou; Guodong Yu; Lihong Liu; Qian Gao; Lei Feng; Yuan Wang

doi:10.15537/smj.2023.44.1.20220677

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Figure 1
- Progression-free survival of the insulin resistance group and non-insulin resistance group. PFS: progression-free survival, IR: insulin resistance, non-IR: non-insulin resistance
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Figure 2
- Overall survival of the insulin resistance group and non-insulin resistance group. OS: overall survival, IR: insulin resistance, non-IR: non-insulin resistance

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Table 1

- Clinical characteristics and univariate analysis of 32 patients with diffuse large B-cell lymphoma of the breast.

Variables	All (n=32)	5 years progression-free survival		5 years overall survival
Variables	All (n=32)	Precentages	P-values	Precentages	P-values
Age at diagnosis	59.13±13.27
≥60 years	18 (56.3)	81%	0.629	81%	0.738
<60 years	14 (43.7)	55%		63%	0.738
Gender
Male	1 (3.1)	--	--	--	--
Female	31 (96.9)	--	--	--	--
Primary site
Left	14 (43.8)	69%	0.171	68%	0.129
Right	16 (50.0)	80%		82%
Bilateral	2 (6.2)	50%		50%
Tumor size	4.15±2.64
≥5 cm	13 (40.6)	74%	0.129	72%	0.172
<5 cm	19 (59.4)	66%	0.129	67%	0.172
Ann-Arbor stage
III-IV	13 (40.6)	61%	0.047*	61%	0.031*
I-II	19 (59.4)	75%	0.047*	71%	0.031*
IPI score
3-5 score	26 (81.2)	67%	0.445	67%	0.360
0-2 score	6 (18.8)	71%	0.445	72%	0.360
B symptoms
Yes	7 (21.9)	52%	0.084	52%	0.026*
No	25 (78.1)	78%	0.084	79%	0.026*
Pathological diagnosis
GCB	7 (21.9)	100%	0.164	100%	0.110
Non-GCB	25 (78.1)	64%	0.164	60%	0.110
Metastasis
Yes	20 (62.5)	64%	0.235	62%	0.204
No	12 (37.5)	88%	0.235	89%	0.204
Recurrence
Yes	11 (34.4)	30%	<0.001^*	40%	0.001^*
No	21 (65.6)	100%	<0.001^*	100%	0.001^*
Outcome
Alive	26 (81.3)	--	--	--	--
Die	6 (18.7)	--	--	--	--
Comorbidities
Yes	25 (78.1)	69%	0.468	69%	0.457
No	7 (21.9)	73%	0.468	73%	0.457
Insulin (uU/ml)	10.54±6.10	--	--	--	--
FPG (mmol/L)	5.93±2.50	--	--	--	--
HOMA-IR	2.45±0.74
>2.7	18 (56.2)	63%	0.864	66%	0.885
≤2.7	14 (43.8)	78%	0.864	79%	0.885

Values are presented as numbers and prescentages (%).

↵* P-value of <0.05 was significant. IPI: international prognostic index, GCB: germinal center B-cell, FPG: fasting plasma glucose, HOMA-IR: homeostasis model assessment of insulin resistance

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Table 2

- Multivariate analysis of prognostic factors for progression-free survival and overall survival in 32 patients with diffuse large B-cell lymphoma of the breast

Factors	Progression-free survival			Overall survival
	HR	95% CI	P-values	HR	95%CI	P-values
Ann Arbor stage (III-IV, I-II)	2.18	0.20-23.33	0.519	3.75	0.39-36.15	0.25
B symptoms (Yes, No)	3.34	0.55-20.46	0.19	3.60	0.54-24.08	0.19
Recurrence (Yes, No)	10.99	1.16-104.37	0.037^*	7.59	0.87-66.13	0.066

↵* P-value of <0.05 was significant. HR: hazard ratio, CI: confidence interval

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Table 3

- Immunohistochemistry in 32 patients with primary diffuse large B-cell lymphoma of the breast.

Immunohistochemistry	All	5 years progression-free survival		5 years overall survival
		Precentages	P-values	Precentages	P-values
Ki-67
≥90%	8 (25.0)	85%	0.714	86%	0.670
<90%	24 (75.0)	69%	0.714	68%	0.670
BCL-2
Positive	24 (75.0)	74%	0.455	72%	0.629
Negative	8 (25.0)	73%	0.455	75%	0.629
BCL-6
Positive	21 (65.6)	89%	0.072	90%	0.107
Negative	11 (34.4)	42%	0.072	50%	0.107
C-MYC
Positive	25 (78.1)	18%	0.001^*	29%	0.004^*
Negative	7 (21.9)	48%	0.001^*	48%	0.004^*
CD79
Positive	7 (21.9)	69%	0.438	71%	0.583
Negative	25 (78.1)	73%	0.438	70%	0.583
PAX-5
Positive	10 (31.2)	26%	0.001^*	18%	0.001^*
Negative	22 (68.8)	94%	0.001^*	95%	0.001^*
MUM1
Positive	29 (90.6)	73%	0.617	73%	0.547
Negative	3 (9.4)	67%	0.617	67%	0.547
CD5
Positive	5 (15.6)	100%	0.279	100%	0.228
Negative	27 (84.4)	68%	0.279	66%	0.228

Values are presented as numbers and prescentages (%).

↵* Significant (p<0.05).

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Table 4

- The treatment of patients with primary diffuse large B-cell lymphoma of the breast (N=32).

Treatments	All	5 years progression-free survival		5 years overall survival
		Precentages	P-values	Precentages	P-values
Mastectomy
No	22 (68.8)	59%	0.917	60%	0.984
Yes	10 (31.2)	77%		79%	0.984
Chemotherapy
Yes	30 (93.8)	--	--	--	--
No	2 (6.2)	--	--	--	--
Cycles of chemotherapy
≥4cycles	28 (87.5)	67%	0.303	68%	0.301
<4cycles	4 (12.5)	100%	0.303	100%	0.301
Radiotherapy
Yes	8 (25.0)	69%	0.321	73%	0.593
No	24 (75.0)	75%		72%	0.593
Intrathecal therapy
Yes	8 (25.0)	85%	0.699	86%	0.703
No	24 (75.0)	69%	0.699	70%	0.703
Transplantation
Yes	2 (6.2)	--	--	--	--
No	30 (93.8)	--	--	--	--
Responses
CR	21 (65.6)	95%	0.007^*	95%	0.015^*
PR	3 (9.4)	33%		33%
SD	0 (0.0)	--		--
PD	8 (25.0)	32%		54%