Follicular lymphoma (FL) is usually diagnosed at an advanced stage when the patient presents with a palpable lymph node or symptoms such as pain and fatigue. However, due to advances in imaging techniques used for many diseases and cancer screening, incidental diagnosis of FL is expected to rise. In this study, we investigated FL disease characteristics and outcomes in patients diagnosed incidentally versus symptomatically, providing insights into what might be detected with multi-cancer early detection tests (MCEDs). We conducted a review of 908 patients with newly diagnosed FL enrolled in the Mayo Clinic component of the Molecular Epidemiology Resource (MER) from 2002 to 2015. We compared disease characteristics and outcomes between the incidental and symptomatic groups. Of the 908 patients, 259 (28.5%) were diagnosed incidentally. The incidental group was more likely to present with early-stage disease (stage I/II: 43.2% vs. 30.6%, p = 0.0003), normal lactate dehydrogenase (LDH) levels (87.2% vs. 80.8%, p = 0.03), and trended towards having lower FLIPI scores (49.8% vs. 42.2%, p = 0.1). However, there were no significant differences in event-free survival (EFS), overall survival (OS) or lymphoma-specific survival (LSS) between the two groups. In conclusion, incidental detection of FL is associated with earlier stages and more favorable disease characteristics. However, this did not translate into improved survival outcomes. Whether even earlier detection of FL using emerging MCEDs translates into improved outcomes remains an open question requiring further investigation.
滤泡性淋巴瘤（FL）通常在患者出现可触及的淋巴结或疼痛、疲劳等症状时于晚期被诊断。然而，由于许多疾病及癌症筛查的影像技术进步，FL的偶然诊断预计将增加。本研究比较了偶然诊断与有症状诊断的FL患者疾病特征及预后，为多癌种早期检测（MCEDs）可能发现的疾病特征提供参考。我们回顾分析了2002年至2015年纳入分子流行病学资源（MER）梅奥诊所中心的908例新诊断FL患者，比较了偶然诊断组与有症状组的疾病特征和预后。在908例患者中，259例（28.5%）为偶然诊断。偶然诊断组更常见于早期疾病（Ⅰ/Ⅱ期：43.2% vs. 30.6%，p=0.0003）、乳酸脱氢酶（LDH）水平正常（87.2% vs. 80.8%，p=0.03），且FLIPI评分较低的趋势更明显（49.8% vs. 42.2%，p=0.1）。但两组在无事件生存期（EFS）、总生存期（OS）和淋巴瘤特异性生存期（LSS）方面无显著差异。综上所述，FL的偶然检测与更早分期和更有利的疾病特征相关，但并未转化为生存结局的改善。使用新兴MCEDs技术更早检测FL是否能改善预后，仍是一个有待进一步研究的问题。
Incidental vs. symptomatic diagnosis of follicular lymphoma: implications of earlier detection
肿瘤(癌症)患者之家