Research Papers:

Sites of extranodal involvement are prognostic in patients with stage 1 follicular lymphoma

Aditi Shastri _, Murali Janakiram, Ioannis Mantzaris, Yiting Yu, Jaime S. Londono, Amit K. Verma and Stefan K. Barta

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Oncotarget. 2017; 8:78410-78418. https://doi.org/10.18632/oncotarget.19240

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Aditi Shastri1, Murali Janakiram1, Ioannis Mantzaris1, Yiting Yu2, Jaime S. Londono1, Amit K. Verma1 and Stefan K. Barta3

1Division of Hematologic Malignancies, Department of Oncology, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, NY, USA

2Department of Biostatistics, Albert Einstein College of Medicine, Bronx, NY, USA

3Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA

Correspondence to:

Aditi Shastri, email: [email protected]

Keywords: follicular lymphoma, Surveillance, Epidemiology and End Results database, prognosis, extranodal disease

Received: March 29, 2017     Accepted: June 19, 2017     Published: July 14, 2017


Objectives: Follicular lymphoma (FL) is the most common indolent B cell lymphoma in the United States and a quarter of patients present with stage I disease. The objective of this study was to examine if primary site of disease influences survival in early stage lymphoma.

Results: The most common extranodal primary sites were the integumentary system (8%), followed by the GI tract (6.4%) and head & neck (5.6%). We stratified patients into a pre-rituximab era (1983-1998) and the rituximab era (1999-2011). In multivariable analysis, integumentary disease was associated with better overall survival (Hazard Ratio [HR], 0.77; Confidence Interval [CI], 0.66-0.9) while primary site FL of the nervous system (HR, 2.40; CI, 1.72-3.38) and the musculoskeletal system (HR, 2.14; CI, 1.44-3.18) were associated with worse overall survival when compared to primary nodal FL. Treatment in the pre-rituximab era, male gender and older age at diagnosis were associated with worse survival.

Methods: We queried the SEER database from 1983 to 2011. We included all adult patients (>18 years) with histologically confirmed stage I FL, active follow-up, and a single primary tumor. A total of 9,865 patients met eligibility criteria, with 2520 (25%) having an extranodal primary site. We classified the primary sites by organ or anatomic location into 11 sites.

Conclusion: Primary site of disease is a prognostic factor for patients with early stage FL and may help identify subsets of patients that could benefit from early, aggressive treatment.

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