睾丸弥漫大B细胞淋巴瘤的临床病理特征和预后分析

OBJECTIVE: To analyze the clinicopathologic characteristics and prognosis of testicular diffuse large B-cell lymphoma（DLBCL）. METHODS: A retrospective analysis was performed on 68 patients with testicular DLBCL admitted to Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine from October 2001 to April 2020. The gene mutation profile was evaluated by targeted sequencing（55 lymphoma-related genes）, and prognostic factors were analyzed. RESULTS: A total of 68 patients were included, of whom 45（66.2％）had primary testicular DLBCL and 23（33.8％）had secondary testicular DLBCL. The proportion of secondary testicular DLBCL patients with Ann Arbor stage Ⅲ–Ⅳ（P<0.001）, elevated LDH（P<0.001）, ECOG score ≥ 2 points（P＝0.005）, and IPI score 3–5 points（P<0.001）is higher than that of primary testicular DLBCL patients. Sixty-two（91％）patients received rituximab in combination with cyclophosphamide, adriamycin, vincristine, and prednisone（R-CHOP）-based first-line regimen, whereas 54 cases（79％）underwent orchiectomy prior to chemotherapy. Patients with secondary testicular DLBCL had a lower estimated 5-year progression-free survival（PFS）rate（16.5％ vs 68.1％, P<0.001）and 5-year overall survival（OS）rate（63.4％ vs 74.9％, P＝0.008）than those with primary testicular DLBCL, and their complete remission rate（57％ vs 91％, P＝0.003）was also lower than that of primary testicular DLBCL. The ECOG scores of ≥2（PFS: P＝0.018; OS: P<0.001）, Ann Arbor stages Ⅲ–Ⅳ（PFS: P<0.001; OS: P＝0.018）, increased LDH levels（PFS: P＝0.015; OS: P＝0.006）, and multiple extra-nodal involvements（PFS: P<0.001; OS: P＝0.013）were poor prognostic factors in testicular DLBCL. Targeted sequencing data in 20 patients with testicular DLBCL showed that the mutation frequencies of ≥20％ were PIM1（12 cases, 60％）, MYD88（11 cases, 55％）, CD79B（9 cases, 45％）, CREBBP（5 cases, 25％）, KMT2D（5 cases, 25％）, ATM（4 cases, 20％）, and BTG2（4 cases, 20％）. The frequency of mutations in KMT2D in patients with secondary testicular DLBCL was higher than that in patients with primary testicular DLBCL（66.7％ vs 7.1％, P＝0.014）and was associated with a lower 5-year PFS rate in patients with testicular DLBCL（P＝0.019）. CONCLUSION: Patients with secondary testicular DLBCL had worse PFS and OS than those with primary testicular DLBCL. The ECOG scores of ≥2, Ann Arbor stages Ⅲ–Ⅳ, increased LDH levels, and multiple extra-nodal involvements were poor prognostic factors in testicular DLBCL. PIM1, MYD88, CD79B, CREBBP, KMT2D, ATM, and BTG2 were commonly mutated genes in testicular DLBCL, and the prognosis of patients with KMT2D mutations was poor.