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| Primary lymphomas of the genitourinary tract: A population-based study |
Carlotta Palumboa,b,Elio Mazzonea,c,d,Francesco A. Mistrettaa,e,Sophie Knippera,f,Zhe Tiana,Paul Perrotteg,Francesco Montorsic,d,Shahrokh F. Shariath,i,j,k,l,Fred Saada,g,Claudio Simeoneb,Alberto Brigantic,d,Alessandro Antonellib,*( ),Pierre I. Karakiewicza,g
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aCancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
bUrology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
cDivision of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
dVita-Salute San Raffaele University, Milan, Italy
eDepartment of Urology, European Institute of Oncology, Milan, Italy
fMartini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
gDivision of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
hDepartment of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
iDepartment of Urology, Weill Cornell Medical College, New York, NY, USA
jDepartment of Urology, University of Texas Southwestern, Dallas, TX, USA
kDepartment of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic
lInstitute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia |
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Abstract Objective: We performed a population-based analysis focusing on primary extranodal lymphoma of either testis, kidney, bladder or prostate (PGUL).
Methods: We identified all cases of localized testis, renal, bladder and prostate primary lymphomas (PL) versus primary testis, kidney, bladder and prostate cancers within the Surveillance, Epidemiology, and End Results database (1998-2015). Estimated annual proportion change methodology (EAPC), multivariable logistic regression models, cumulative incidence plots and multivariable competing risks regression models were used.
Results: The rates of testis-PL, renal-PL, bladder-PL and prostate-PL were 3.04%, 0.22%, 0.18% and 0.01%, respectively. Patients with PGUL were older and more frequently Caucasian. Annual rates significantly decreased for renal-PL (EAPC: -5.6%; p=0.004) and prostate-PL (EAPC: -3.6%; p=0.03). In multivariable logistic regression models, older ager independently predicted testis-PL (odds ratio [OR]: 16.4; p<0.001) and renal-PL (OR: 3.5; p<0.001), while female gender independently predicted bladder-PL (OR: 5.5; p<0.001). In surgically treated patients, cumulative incidence plots showed significantly higher 10-year cancer-specific mortality (CSM) rates for testis-PL, renal-PL and prostate-PL versus their primary genitourinary tumors. In multivariable competing risks regression models, only testis-PL (hazard ratio [HR]: 16.7; p<0.001) and renal-PL (HR: 2.52; p<0.001) independently predicted higher CSM rates.
Conclusion: PGUL rates are extremely low and on the decrease in kidney and prostate but stable in testis and bladder. Relative to primary genitourinary tumors, PGUL are associated with worse CSM for testis-PL and renal-PL but not for bladder-PL and prostate-PL, even after adjustment for other-cause mortality.
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Received: 17 April 2019
Available online: 27 November 2019
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Corresponding Authors:
Alessandro Antonelli
E-mail: alessandro_antonelli@me.com
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| Testicular tumors (n=15 452) | Renal tumors (n=111 955) | Bladder tumors (n=93 780) | Prostate tumors (n=721 734) | | PL (n=470; 3.0%) | GCTT (n=14 972; 97%) | p-Value | PL (n=249; 0.2%) | RCC (n=111 706; 99.8%) | p-Value | PL (n=169; 0.2%) | TCC (n=93 611; 99.8%) | p-Value | PL (n=8; 0.01%) | PCa (n=721 651; 99.9%) | p-Value | | Age, median (IQR), year | 71 (58.5-78) | 34 (28-42) | <0.001 | 62 (52-70) | 71 (63-78) | <0.001 | 77 (67-84) | 74 (65-81) | 0.01 | 72 (63.5-78) | 67 (60-74) | 0.001 | | Surgery performed, n (%) | 458 (97.4) | 14 929 (99.6) | | 96 (38.6) | 102 380 (91.7) | | 116 (68.6) | 89 847 (96.0) | | 46 (55.4) | 233 565 (32.4) | | | Gender, n (%) | | Male | 470 (100) | 14 972 (100) | - | 156 (62.7) | 69 015 (61.8) | <0.001 | 60 (35.5) | 71 567 (76.5) | <0.001 | 83 (100) | 721 651 (100) | - | | Female | - | - | - | 93 (37.3) | 42 691 (38.2) | | 109 (64.5) | 22 044 (23.5) | | - | - | - | | Race, n (%) | | Caucasian | 398 (84.7) | 13 518 (90.2) | <0.001 | 207 (83.1) | 91 087 (81.5) | 0.017 | 143 (84.6) | 83 934 (89.7) | 0.01 | 64 (77.1) | 567 980 (78.7) | 0.002 | | African-American | 25 (5.3) | 404 (2.7) | | 19 (7.6) | 13 695 (12.3) | | 10 (5.9) | 5 316 (5.7) | | 6 (7.2) | 103 123 (14.3) | | | Other | 47 (10.0) | 1 060 (7.1) | | 23 (9.2) | 6 924 (6.2) | | 16 (9.5) | 4 361 (4.7) | | 13 (15.7) | 50 631 (7.0) | | | Marital status, n (%) | | | | 140 (56.2) | | | | | | | | | | Married | 319 (67.9) | 6 997 (46.7) | <0.001 | 38 (15.3) | 69 650 (62.4) | 0.025 | 77 (45.6) | 55 009 (58.8) | 0.001 | 54 (65.1) | 478 102 (66.2) | 0.04 | | Never married | 53 (11.3) | 6 158 (41.1) | | 63 (25.3) | 15 686 (14.0) | | 18 (10.7) | 9 019 (9.6) | | 12 (14.5) | 64 574 (8.9) | | | Previously married | 74 (15.7) | 773 (5.2) | | 8 (3.2) | 20 784 (18.6) | | 64 (37.9) | 23 742 (25.4) | | 13 (15.7) | 84 514 (11.7) | | | Unknown | 24 (5.1) | 1 054 (7.0) | | 140 (56.2) | 5 586 (5.0) | | 10 (5.9) | 5 841 (6.2) | | 4 (4.8) | 94 544 (13.1) | |
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Descriptive characteristics of primary lymphoma versus genitourinary malignancies according to sites of origin: Identified within the Surveillance, Epidemiology and End Results database from 1998 to 2015.
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| Variables | Primary testicular lymphoma (n=470) | Primary kidney lymphoma (n=249) | Primary bladder lymphoma (n=169) | Primary prostatic lymphoma (n=83) | | Histological subtype, n (%) | | Mantle cell | 3 (0.6) | 0 (0) | 2 (1.2) | 5 (6.0) | | Marginal zone | 1 (0.2) | 57 (22.9) | 46 (27.2) | 16 (19.3) | | Follicular | 0 (0) | 24 (9.6) | 7 (4.1) | 6 (7.2) | | Small lymphocytic | 3 (0.6) | 5 (2.0) | 11 (6.5) | 9 (10.8) | | Lymphoplasmacytic | 0 (0) | 5 (2.0) | 1 (0.6) | 0 (0) | | Mixed small large | 2 (0.4) | 1 (0.4) | 0 (0) | 2 (2.4) | | DLBC | 393 (83.6) | 110 (44.2) | 71 (42.0) | 30 (36.1) | | Burkitt | 3 (0.6) | 4 (1.6) | 1 (0.6) | 1 (1.2) | | Lymphoblastic | 4 (0.9) | 3 (1.2) | 1 (0.6) | 0 (0) | | Peripheral T cell | 6 (1.3) | 3 (1.2) | 0 (0) | 0 (0) | | Not specified | 44 (9.4) | 37 (14.9) | 29 (17.2) | 14 (16.9) | | Grade, n (%) | | Low | 20 (4.3) | 92 (36.9) | 67 (39.6) | 38 (45.8) | | High | 406 (86.4) | 120 (48.2) | 73 (43.2) | 31 (37.3) | | Not specified | 44 (9.4) | 37 (14.9) | 29 (17.2) | 14 (16.9) |
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Descriptive characteristics of patients diagnosed with primary testicular lymphoma, primary renal lymphoma, primary bladder lymphoma or primary prostate lymphoma, identified within the Surveillance, Epidemiology and End Results database from 1998 to 2015.
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| Variables | Testis | Kidney | Bladder | Prostate | | OR (95% CI) | p-Value | OR (95% CI) | p-Value | OR (95% CI) | p-Value | OR (95% CI) | p-Value | | Age, year | 16.4 (9.3-30.8) | <0.001 | 3.5 (2.3-5.4) | <0.001 | 0.6 (0.3-1.2) | 0.04 | 0.4 (0.2-0.9) | 0.04 | | Gender | | Male | - | - | Ref | - | Ref | - | - | - | | Female | - | - | 0.8 (0.6-1.1) | 0.3 | 5.5 (3.8-7.8) | <0.001 | - | - | | Race | | Caucasian | Ref | - | Ref | - | Ref | - | Ref | - | | African-American | 3.1 (1.8-5.3) | <0.001 | 0.7 (0.4-1.1) | 0.09 | 0.8 (0.4-1.4) | 0.5 | 0.5 (0.2-1.1) | 0.1 | | Other | 2.4 (1.6-3.6) | <0.001 | 1.6 (1.1-2.4) | 0.03 | 2.1 (1.2-3.4) | 0.005 | 2.6 (1.4-4.6) | 0.002 | | Marital status | | Married | Ref | - | Ref | - | Ref | - | Ref | - | | Never married | 0.7 (0.5-0.9) | 0.02 | 1.7 (1.1-2.4) | 0.03 | 1.1 (0.6-1.7) | 0.8 | 1.9 (0.9-3.4) | 0.04 | | Previously married | 1.1 (0.8-1.6) | 0.4 | 1.2 (0.9-1.7) | 0.19 | 0.9 (0.6-1.3) | 0.8 | 1.3 (0.9-2.3) | 0.3 | | Unknown | 0.7 (0.4-1.1) | 0.1 | 0.7 (0.3-1.4) | 0.44 | 0.5 (0.2-0.9) | 0.05 | 0.3 (0.1-0.8) | 0.03 | | Year of diagnosis | | 1998-2003 | Ref | - | Ref | - | Ref | - | Ref | - | | 2004-2009 | 0.7 (0.5-0.9) | 0.01 | 0.81 (0.58-1.13) | 0.22 | 1.1 (0.7-1.5) | 0.8 | 1.1 (0.7-1.9) | 0.6 | | 2010-2015 | 0.6 (0.4-0.8) | <0.001 | 0.78 (0.56-1.09) | 0.13 | 0.7 (0.5-1.1) | 0.09 | 0.6 (0.3-1.2) | 0.2 |
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Multivariable logistic regression analyses predicting localized primary extranodal lymphoma of either testis (n=470), kidney (n=249), bladder (n=169) or prostate (n=83), identified within the Surveillance, Epidemiology, and End Results database from 1998 to 2015.
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Cumulative incidence plots depicting cancer specific mortality (CSM) adjusted for other cause mortality (OCM) in (A) primary testicular lymphoma vs. germ cell tumor, (B) renal cell carcinoma vs. primary renal lymphoma, (C) transitional cell carcinoma of the bladder vs. primary bladder lymphoma and (D) prostate adenocarcinoma vs. primary prostatic lymphoma.
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| Testis | Kidney | Bladder | Prostate | | HR (95% CI) | p-Value | HR (95% CI) | p-Value | HR (95% CI) | p-Value | HR (95% CI) | p-Value | | Histology | | Primary tumor | 1.0 (Ref.) | - | 1.0 (Ref.) | - | 1.0 (Ref.) | - | 1.0 (Ref.) | - | | Lymphoma | 17.3 (10.7-28.1) | <0.001 | 1.8 (0.9-3.4) | 0.06 | 1.0 (0.7-1.6) | 0.75 | 6.3 (3.1-12.5) | <0.001 | | Age, year | | <50 | 0.7 (0.4-1.2) | 0.21 | 1.0 (Ref.) | - | 1.0 (Ref.) | - | 1.0 (Ref.) | - | | 50-59 | 1.4 (0.8-2.2) | 0.16 | 1.5 (1.4-1.7) | <0.001 | 1.1 (0.9-1.2) | 0.09 | 1.7 (1.3-2.3) | <0.001 | | 60-69 | 1.3 (0.7-2.5) | 0.38 | 1.9 (1.7-2.0) | <0.001 | 1.2 (1.1-1.4) | <0.001 | 3.1 (2.4-4) | <0.001 | | 70-79 | 2.1 (1.1-4.1) | 0.016 | 2.4 (2.2-2.6) | <0.001 | 1.5 (1.4-1.7) | <0.001 | 8.4 (6.6-10.9) | <0.001 | | >80 | 1.8 (0.9-3.7) | 0.09 | 3.4 (3.1-3.9) | <0.001 | 2.6 (2.3-2.9) | <0.001 | 30.8 (23.9-39.6) | <0.001 | | Gender | | Male | - | - | 1.0 (Ref.) | - | 1.0 (Ref.) | - | - | - | | Female | - | - | 0.8 (0.7-0.8) | <0.001 | 1.2 (1.2-1.2) | <0.001 | - | - | | Race | | Caucasian | 1.0 (Ref.) | - | 1.0 (Ref.) | - | 1.0 (Ref.) | - | 1.0 (Ref.) | - | | African-American | 1.8 (0.9-3.0) | 0.08 | 1.1 (1.0-1.2) | 0.006 | 1.4 (1.3-1.5) | <0.001 | 1.6 (1.5-1.7) | <0.001 | | Other | 0.5 (0.3-1.1) | 0.09 | 1.1 (0.9-1.1) | 0.68 | 0.9 (0.8-0.9) | 0.02 | 0.7 (0.6-0.8) | <0.001 | | Year of diagnosis | | 1998-2003 | 1.0 (Ref.) | - | 1.0 (Ref.) | - | 1.0 (Ref.) | - | 1.0 (Ref.) | - | | 2004-2009 | 0.7 (0.5-0.9) | 0.02 | 0.7 (0.6-0.7) | <0.001 | 1.0 (0.9-1.0) | 0.8 | 0.7 (0.6-0.7) | <0.001 | | 2010-2015 | 0.6 (0.4-0.9) | 0.01 | 0.5 (0.4-0.5) | <0.001 | 0.9 (0.8-0.9) | 0.001 | 0.6 (0.5-0.6) | <0.001 |
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Multivariable competing risks regression models predicting cancer-specific mortality according to presence or absence of lymphoma in testis, kidney, bladder and prostate cancer patients. All models are also adjusted for other-cause mortality.
|
| [1] |
Non-Hodgkin Lymphoma. Cancer stat facts. SEER. https://seer.cancer.gov/statfacts/html/nhl.html. [Accessed 12 April 2019].
|
| [2] |
Armitage JO, Gascoyne RD, Lunning MA, Cavalli F. Non-Hodgkin lymphoma. Lancet 2017; 390:298-310.
pmid: 28153383
|
| [3] |
Cheah CY, Wirth A, Seymour JF. Primary testicular lymphoma. Blood 2014; 123:486-93.
pmid: 24282217
|
| [4] |
Vannata B, Zucca E. Primary extranodal B-cell lymphoma: current concepts and treatment strategies. Chin Clin Oncol 2015;4:17. https://doi.org/10.3978/j.issn.2304-3865.2014.12.01.
pmid: 26112803
|
| [5] |
Lontos K, Tsagianni A, Msaouel P, Appleman LJ, Nasioudis D. Primary urinary tract lymphoma: rare but aggressive. Anticancer Res 2017; 37:6989-95.
pmid: 29187485
|
| [6] |
Gundrum JD, Mathiason MA, Moore DB, Go RS. Primary testicular diffuse large B-cell lymphoma: a population-based study on the incidence, natural history, and survival comparison with primary nodal counterpart before and after the introduction of rituximab. J Clin Oncol 2009; 27:5227-32.
pmid: 19770371
|
| [7] |
Martín OD, Wadskier LA, Quiroz Y, Bravo HP, Cacciamani G, Uma?a P, et al. Primary non-Hodgkin lymphoma of the prostate: a case report. Ecancer medical science 2017;1:789. https://doi.org/10.3332/ecancer.2017.789.
|
| [8] |
About the SEER program. SEER. https://seer.cancer.gov/about/overview.html. [Accessed 12 April 2019].
|
| [9] |
Ruhl J, Adamo M, Dickie L, Negoita S. Hematopoietic and lymphoid neoplasm coding manual. 2015. https://seer. cancer.gov/tools/heme/Hematopoietic_Instructions_and_Rules.pdf. [Accessed 12 April 2019].
|
| [10] |
Adamo M, Dickie L, Ruhl J. SEER program coding and staging manual. 2018. https://seer.cancer.gov/manuals/2018/SPCSM_2018_maindoc.pdf. [Accessed 12 April 2019].
|
| [11] |
WHO classification of tumours of haematopoietic and lymphoid tissues: International Agency for Research on Cancer. 4th ed. 2008. https://publications.iarc.fr/Book-And- Report-Series/Who-Iarc-Classification-Of-Tumours/Who-Classification-Of-Tumours-Of-Haematopoietic-And-Lymphoid-Tissues-2017. [Accessed 12 April 2019].
|
| [12] |
Fay MP, Tiwari RC, Feuer EJ, Zou Z. Estimating average annual percent change for disease rates without assuming constant change. Biometrics 2006; 62:847-54.
pmid: 16984328
|
| [13] |
Sellman DP, Simpson WG, Klaassen Z, Jen RP DiBianco JM, Reinstatler L, et al. Characterization and outcomes of local treatment for primary bladder lymphoma: a population-based cohort analysis. Urol Ann 2018; 10:249-53.
pmid: 30089981
|
| [14] |
Groves FD, Linet MS, Travis LB, Devesa SS. Cancer surveillance series: non-Hodgkin’s lymphoma incidence by histologic subtype in the United States from 1978 through 1995. J Natl Cancer Inst 2000; 92:1240-51.
doi: 10.1093/jnci/92.15.1240
pmid: 10922409
|
| [15] |
Mu¨ller AMS, Ihorst G, Mertelsmann R, Engelhardt M. Epidemiology of non-Hodgkin’s lymphoma (NHL): trends, geographic distribution, and etiology. Ann Hematol 2005; 84:1-12.
pmid: 15480663
|
| [16] |
Ganeshan D, Iyer R, Devine C, Bhosale P, Paulson E. Imaging of primary and secondary renal lymphoma. AJR Am J Roentgenol 2013; 201:W712-9. https://doi.org/10.2214/AJR.13.10669.
doi: 10.2214/AJR.13.10669
pmid: 24147501
|
| [17] |
Bertolotto M, Derchi LE, Secil M, Dogra V, Sidhu PS, Clements R, et al. Grayscale and color Doppler features of testicular lymphoma. J Ultrasound Med 2015; 34:1139-45.
pmid: 26014335
|
| [18] |
Vitolo U, Ferreri AJM, Zucca E. Primary testicular lymphoma. Crit Rev Oncol Hematol 2008; 65:183-9.
pmid: 17962036
|
| [1] |
Yucong Zhang,Gongwei Long,Haojie Shang,Beichen Ding,Guoliang Sun,Wei Ouyang,Man Liu,Yuan Chen,Heng Li,Hua Xu,Zhangqun Ye. Comparison of the oncological, perioperative and functional outcomes of partial nephrectomy versus radical nephrectomy for clinical T1b renal cell carcinoma: A systematic review and meta-analysis of retrospective studies[J]. Asian Journal of Urology, 2021, 8(1): 117-125. |
| [2] |
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