Duodenal Lymphomas: Comprehensive Evaluation of Endoscopic Features and Clinical Outcomes in a Tertiary Center

Background/Objectives: Duodenal lymphomas (DLs) are a rare subset of gastrointestinal lymphomas with incompletely characterized clinicopathological features due to low incidence and diagnostic challenges. This study assessed DL survival outcomes, characterized clinical/endoscopic features, and identified prognostic factors. Methods: This was a retrospective observational study of patients undergoing endoscopic examinations between 1 November 2002 and 1 November 2022 at Peking Union Medical College Hospital, with a subsequent histopathological diagnosis of DL. The primary outcome was overall survival (OS), and Cox proportional hazards modeling was used for survival analyses. Results: Sixteen patients (32%) had indolent B-cell lymphoma, 20 (40%) had aggressive B-cell lymphoma, and 14 (28%) had T-cell lymphoma. Diarrhea and weight loss were more common in patients with T-cell lymphoma. The most common endoscopic appearance was mucosal granularity, and 40% of patients had mass lesions. The median OS was 24.1 (95% CI: 13.3-117) months, with 1- and 5-year survival rates of 68.0% (95% CI: 56.2-82.2%) and 33.8% (95% CI: 22.3-51.44%), respectively. In multivariable analysis, a granular appearance (HR: 0.33, 95% CI: 0.11-0.99, and p = 0.049) and taking chemotherapy (HR: 0.22, 95% CI: 0.07-0.69, and p = 0.01) were associated with better OS, while T-cell lymphoma (HR: 9.19, 95% CI: 2.12-32.83, and p = 0.003) and stage IV lymphoma (HR: 12.76, 95% CI: 1.70-95.66, and p = 0.013) were associated with worse OS. Conclusions: This first integrated study provides new information on the clinical, endoscopic, and prognostic features of DL. While no specific clinical or endoscopic feature is diagnostic of DL, DL must remain in the differential diagnosis of any patient presenting with nonspecific gastrointestinal symptoms.