Uncertainty and discordance in the staging and prognosis of diffuse large B-cell lymphoma with isolated bilateral testicular involvement

The Ann Arbor staging was originally developed in 1971 for Hodgkin lymphoma at a time when radiation was the primary treatment [1]. It was subsequently adopted for use in non-Hodgkin lymphoma (NHL). Although the Ann Arbor staging continues to be valuable in nodal NHL, its application in extranodal NHL has limitations [2,3]. Proper staging and accurate prognosis of diffused large B-cell lymphoma (DLBCL) with isolated bilateral testicular involvement are unclear. Here we show that even lymphoma experts do not have a consensus on these issues with 60.7% choosing Stage IV and the remaining favoring either Stage I_E or II_E. To determine the prognosis of DLBCL patients with isolated bilateral testicular involvement, we performed disease-specific survival analyses using data from the Surveillance Epidemiology and End Results Program (SEER). The survival was not significantly different from age-matched Stage II unilateral disease (P = 0.549) and was better when compared with Stage IV unilateral disease (P = 0.034). Our study suggests that a limited stage designation is more appropriate due to a relatively better prognosis. To provide uniform staging for clinical trial and prognostic purposes, development of site- and histology-specific modified staging for primary extranodal lymphoma involving paired organs may be warranted.