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Annals of Oncology Advance Access published online on October 16, 2006
Annals of Oncology, doi:10.1093/annonc/mdl349
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© 2006 European Society for Medical Oncology
Received June 17, 2006
Revised August 14, 2006
Accepted August 23, 2006

original article

Clinicopathological features of pyothorax-associated lymphoma; a retrospective survey involving 98 patients

H. Narimatsu 1, Y. Ota 2, M. Kami 3 *, K. Takeuchi 4, R. Suzuki 5, K. Matsuo 6, T. Matsumura 3, K. Yuji 3, Y. Kishi 7, T. Hamaki 8, U. Sawada 9, S. Miyata 10, T. Sasaki 11, K. Tobinai 12, M. Kawabata 13, Y. Atsuta 14, Y. Tanaka 15, R. Ueda 16, and S. Nakamura 17

1 Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya
2 Department of Pathology, Toranomon Hospital, Tokyo
3 Division of Exploratory Research, the Institute of Medical Science, the University of Tokyo, Tokyo
4 Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo
5 Division of Molecular Medicine, Aichi Cancer Center, Nagoya
6 Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya
7 Division of Genetic Therapeutics, Center for Molecular Medicine, Jichi Medical School, Tochigi
8 Department of Transfusion Medicine, Metropolitan Fuchu Hospital, Tokyo
9 First Department of Internal Medicine, Nihon University School of Medicine, Tokyo
10 Department of Radiology, Toyama Prefectural Central Hospital, Toyama
11 Department of Chemotherapy, Tokyo Metropolitan Komagome Hospital, Tokyo
12 Hematology Division, National Cancer Center Hospital, Tokyo
13 Division of Respiratory Diseases, Toranomon Hospital, Tokyo
14 Division of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya
15 Third Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Tokyo
16 Department of Internal Medicine and Molecular Science, Nagoya City University School of Medicine, Nagoya
17 Department of Clinical Pathology, Nagoya University Graduate School of Medicine, Nagoya, Japan

* To whom correspondence should be addressed.
M. Kami, E-mail: kami-tky{at}umin.ac.jp


  Abstract

To investigate clinicopathological features of pyothorax-associated lymphoma (PAL), we examined medical records of 98 patients (88 males and 10 females) with PAL at a median age of 70 years (range 51-86). Seventy-nine patients had a history of artificial pneumothorax. Median interval between diagnosis and artificial pneumothorax was 43 years (range 19-64). At diagnosis, performance status (PS) was 0-1 (n = 56) and 2-4 (n = 42). Clinical stages were I (n = 42), II (n = 26), III (n = 8) and IV (n = 22). Pathological diagnosis comprised diffuse large-B-cell (n = 78) and peripheral T-cell lymphoma (n = 1). Seventeen were treated supportively. The other 81 received aggressive treatments; chemotherapy (n = 52), radiotherapy (n = 7), surgery (n = 4) and combination (n = 18). Five-year overall survival (OS) was 0.35 (95% confidence interval, 24% to 45%). Causes of deaths were PAL (n = 39), respiratory failure (n = 13) and others (n = 12). Multivariate analysis identified prognostic factors for OS; lactate dehydrogenase levels [hazard ratio (HR) = 2.36; P = 0.013], sex (female versus male) (HR = 0.15; P = 0.01), PS (2-4 versus 0-1) (HR = 2.20; P = 0.02), clinical stages (III/IV versus I/II) (HR = 1.95; P = 0.037) and chemotherapy (HR = 0.31; P = 0.01). Most patients with PAL are elderly and have comorbidities, while some of them achieve durable remission with appropriate treatments. These findings prompt us to establish an optimal treatment strategy on the basis of risk stratification of individual patients.

Keywords: artificial pneumothorax; diffuse large B-cell lymphoma; Epstein-Barr virus; malignant lymphoma; tuberculosis.
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