Gastroenterology

Gastroenterology

Volume 119, Issue 5, November 2000, Pages 1191-1202
Gastroenterology

Alimentary Tract
Primary gastric B-Cell lymphoma: Results of a prospective multicenter study,☆☆,

https://doi.org/10.1053/gast.2000.19579Get rights and content

Abstract

Background & Aims: Appropriate management of primary gastric lymphoma is controversial. This prospective, multicenter study aimed to evaluate the accuracy of endoscopic biopsy diagnosis and clinical staging procedures and assess a treatment strategy based on Helicobacter pylori status and tumor stage and grade. Methods: Of 266 patients with primary gastric B-cell lymphoma, 236 with stages EI (n = 151) or EII (n = 85) were included in an intention-to-treat analysis. Patients with H. pylori–positive stage EI low-grade lymphoma underwent eradication therapy. Nonresponders and patients with stage EII low-grade lymphoma underwent gastric surgery. Depending on the residual tumor status and predefined risk factors, patients received either radiotherapy or no further treatment. Patients with high-grade lymphoma underwent surgery and chemotherapy at stages EI/EII, complemented by radiation in case of incomplete resection. Results: Endoscopic-bioptic typing and grading and clinical staging were accurate to 73% and 70%, respectively, based on the histopathology of resected specimens. The overall 2-year survival rates for low-grade lymphoma did not differ in the risk-adjusted treatment groups, ranging from 89% to 96%. In high-grade lymphoma, patients with complete resection or microscopic tumor residuals had significantly better survival rates (88% for EI and 83% for EII) than those with macroscopic tumor residues (53%; P < 0.001). Conclusions: There is a considerable need for improvement in clinical diagnostic and staging procedures, especially with a view toward nonsurgical treatment. With the exception of eradication therapy in H. pylori–positive low-grade lymphoma of stage EI and the subgroup of locally advanced high-grade lymphoma, resection remains the treatment of choice. However, because there is an increasing trend toward stomach-conserving therapy, a randomized trial comparing cure of disease and quality of life with surgical and conservative treatment is needed.

GASTROENTEROLOGY 2000;119:1191-1202

Section snippets

Design

Patients were enrolled at 163 clinical centers in Germany and 13 in Austria. They were accepted for inclusion in the study only if a central histologic review (carried out by A.G. and H.-K. M.-H.) confirmed the diagnosis of primary gastric B-cell lymphoma. The study was approved by the ethics committees of the universities of Würzburg and Vienna. All patients gave written informed consent.

Patients

From March 1993 through March 1996, 266 adult patients with newly diagnosed primary gastric B-cell lymphoma

Clinical features

A total of 266 patients had a diagnosis of primary gastric B-cell lymphoma. Their clinical characteristics are summarized in Table 1.The vast majority of both low-grade and high-grade lymphoma proved to be localized (n = 237; Figure 1), presenting in stage EI/EII in 91% and 88%, respectively (P > 0.05). However, confinement to mucosa and submucosa (stage EI1) was more common in low-grade lymphoma (62%) than in those of high malignancy (13%; P < 0.001). Twenty-eight patients were found to have

Discussion

It has become clear in recent years that primary gastric B-cell lymphoma has a special place among malignant non-Hodgkin's lymphomas, constituting approximately 70% of primary extranodal lymphomas of gastrointestinal origin, because of the tumor's histomorphologic and molecular-genetic characteristics, cell-biologic properties, and clinical behavior, as reflected in the newly formulated REAL classification of malignant lymphoma.12 To our knowledge, this series of primary gastric lymphoma is the

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    Address requests for reprints to: Wolfgang Fischbach, M.D., Medizinische Klinik II, Klinikum Aschaffenburg, Am Hasenkopf, D-63739 Aschaffenburg, Germany. Fax: (49) 6021-323031.

    ☆☆

    Supported by a grant from the German Cancer Research Fund (Deutsche Krebshilfe, Bonn).

    Dedicated to the memory of Thadda ̈us Radaszkiewicz.

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