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Research ArticleOriginal Article
Open Access

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 and Yuan Wang
Saudi Medical Journal January 2023, 44 (1) 38-44; DOI: https://doi.org/10.15537/smj.2023.44.1.20220677
Weiling Zhou
From the Department of Endocrine and Metabolic Diseases (Zhou, Gao, Feng, Wang), from the Department of Hematology (Liu), The Fourth Hospital of Hebei Medical University, Shijiazhuang, and from the Department of Hepatobiliary Surgery (Yu), Affiliated Hospital of Hebei University, Baoding, China.
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Guodong Yu
From the Department of Endocrine and Metabolic Diseases (Zhou, Gao, Feng, Wang), from the Department of Hematology (Liu), The Fourth Hospital of Hebei Medical University, Shijiazhuang, and from the Department of Hepatobiliary Surgery (Yu), Affiliated Hospital of Hebei University, Baoding, China.
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Lihong Liu
From the Department of Endocrine and Metabolic Diseases (Zhou, Gao, Feng, Wang), from the Department of Hematology (Liu), The Fourth Hospital of Hebei Medical University, Shijiazhuang, and from the Department of Hepatobiliary Surgery (Yu), Affiliated Hospital of Hebei University, Baoding, China.
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Qian Gao
From the Department of Endocrine and Metabolic Diseases (Zhou, Gao, Feng, Wang), from the Department of Hematology (Liu), The Fourth Hospital of Hebei Medical University, Shijiazhuang, and from the Department of Hepatobiliary Surgery (Yu), Affiliated Hospital of Hebei University, Baoding, China.
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Lei Feng
From the Department of Endocrine and Metabolic Diseases (Zhou, Gao, Feng, Wang), from the Department of Hematology (Liu), The Fourth Hospital of Hebei Medical University, Shijiazhuang, and from the Department of Hepatobiliary Surgery (Yu), Affiliated Hospital of Hebei University, Baoding, China.
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Yuan Wang
From the Department of Endocrine and Metabolic Diseases (Zhou, Gao, Feng, Wang), from the Department of Hematology (Liu), The Fourth Hospital of Hebei Medical University, Shijiazhuang, and from the Department of Hepatobiliary Surgery (Yu), Affiliated Hospital of Hebei University, Baoding, China.
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  • For correspondence: [email protected]
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  • Figure 1
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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

Tables

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    Table 1

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

    VariablesAll (n=32)5 years progression-free survival5 years overall survival
    PrecentagesP-valuesPrecentagesP-values
    Age at diagnosis59.13±13.27
    ≥60 years18 (56.3)81%0.62981%0.738
    <60 years14 (43.7)55%63%
    Gender
    Male1 (3.1)--------
    Female31 (96.9)
    Primary site
    Left14 (43.8)69%0.17168%0.129
    Right16 (50.0)80%82%
    Bilateral2 (6.2)50%50%
    Tumor size4.15±2.64
    ≥5 cm13 (40.6)74%0.12972%0.172
    <5 cm19 (59.4)66%67%
    Ann-Arbor stage
    III-IV13 (40.6)61%0.047*61%0.031*
    I-II19 (59.4)75%71%
    IPI score
    3-5 score26 (81.2)67%0.44567%0.360
    0-2 score6 (18.8)71%72%
    B symptoms
    Yes7 (21.9)52%0.08452%0.026*
    No25 (78.1)78%79%
    Pathological diagnosis
    GCB7 (21.9)100%0.164100%0.110
    Non-GCB25 (78.1)64%60%
    Metastasis
    Yes20 (62.5)64%0.23562%0.204
    No12 (37.5)88%89%
    Recurrence
    Yes11 (34.4)30%<0.001*40%0.001*
    No21 (65.6)100%100%
    Outcome
    Alive26 (81.3)--------
    Die6 (18.7)
    Comorbidities
    Yes25 (78.1)69%0.46869%0.457
    No7 (21.9)73%73%
    Insulin (uU/ml)10.54±6.10--------
    FPG (mmol/L)5.93±2.50--------
    HOMA-IR2.45±0.74
    >2.718 (56.2)63%0.86466%0.885
    ≤2.714 (43.8)78%79%

    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

    • View popup
    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

    FactorsProgression-free survivalOverall survival
    HR95% CIP-valuesHR95%CIP-values
    Ann Arbor stage (III-IV, I-II)2.180.20-23.330.5193.750.39-36.150.25
    B symptoms (Yes, No)3.340.55-20.460.193.600.54-24.080.19
    Recurrence (Yes, No)10.991.16-104.370.037*7.590.87-66.130.066
    • ↵* P-value of <0.05 was significant. HR: hazard ratio, CI: confidence interval

    • View popup
    Table 3

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

    ImmunohistochemistryAll5 years progression-free survival5 years overall survival
    PrecentagesP-valuesPrecentagesP-values
    Ki-67
    ≥90%8 (25.0)85%0.71486%0.670
    <90%24 (75.0)69%68%
    BCL-2
    Positive24 (75.0)74%0.45572%0.629
    Negative8 (25.0)73%75%
    BCL-6
    Positive21 (65.6)89%0.07290%0.107
    Negative11 (34.4)42%50%
    C-MYC
    Positive25 (78.1)18%0.001*29%0.004*
    Negative7 (21.9)48%48%
    CD79
    Positive7 (21.9)69%0.43871%0.583
    Negative25 (78.1)73%70%
    PAX-5
    Positive10 (31.2)26%0.001*18%0.001*
    Negative22 (68.8)94%95%
    MUM1
    Positive29 (90.6)73%0.61773%0.547
    Negative3 (9.4)67%67%
    CD5
    Positive5 (15.6)100%0.279100%0.228
    Negative27 (84.4)68%66%

    Values are presented as numbers and prescentages (%).

    • ↵* Significant (p<0.05).

    • View popup
    Table 4

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

    TreatmentsAll5 years progression-free survival5 years overall survival
    PrecentagesP-valuesPrecentagesP-values
    Mastectomy
    No22 (68.8)59%0.91760%0.984
    Yes10 (31.2)77%79%
    Chemotherapy
    Yes30 (93.8)--------
    No2 (6.2)
    Cycles of chemotherapy
    ≥4cycles28 (87.5)67%0.30368%0.301
    <4cycles4 (12.5)100%100%
    Radiotherapy
    Yes8 (25.0)69%0.32173%0.593
    No24 (75.0)75%72%
    Intrathecal therapy
    Yes8 (25.0)85%0.69986%0.703
    No24 (75.0)69%70%
    Transplantation
    Yes2 (6.2)--------
    No30 (93.8)
    Responses
    CR21 (65.6)95%0.007*95%0.015*
    PR3 (9.4)33%33%
    SD0 (0.0)----
    PD8 (25.0)32%54%

    Values are presented as numbers and prescentages (%).

    • ↵* Significant (p<0.05). CR: complete remission, PR: partial remission, SD: stable disease, PD: patients progressive disease

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Primary diffuse large B-cell lymphoma of the breast
Weiling Zhou, Guodong Yu, Lihong Liu, Qian Gao, Lei Feng, Yuan Wang
Saudi Medical Journal Jan 2023, 44 (1) 38-44; DOI: 10.15537/smj.2023.44.1.20220677

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Primary diffuse large B-cell lymphoma of the breast
Weiling Zhou, Guodong Yu, Lihong Liu, Qian Gao, Lei Feng, Yuan Wang
Saudi Medical Journal Jan 2023, 44 (1) 38-44; DOI: 10.15537/smj.2023.44.1.20220677
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Keywords

  • breast
  • insulin resistance
  • diffuse large B-cell lymphoma
  • therapy
  • prognosis

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