Advertisement

Annals of Surgical Oncology

, Volume 14, Issue 8, pp 2239–2245 | Cite as

Prognostic Factors in Primary Gastric Lymphoma

  • Heriberto Medina-Franco
  • Santos Soto Germes
  • Carmen Lome Maldonado
Article

Abstract

Background

There is not a gold standard in the treatment of primary gastric lymphoma (PGL). This study aimed to establish prognostic factors that should be considered for the staging and management of this disease.

Methods

We retrospectively reviewed and analyzed the clinicopathological features of patients treated for PGL in a tertiary referral center in Mexico City in a 10-year period from 1990 through 2000. Staging was performed with the Ann-Arbor system. Overall and disease-free survivals were the primary endpoints.

Results

We identified 41 patients of which 19 (46.3%) were classified as large-cell lymphoma, 16 (39.0%) as low-grade MALT, and 6 (14.6%) patients as lymphoma unspecified. The series included 15 (36.6%) patients with stage IV disease. Twenty patients (48.8%) underwent surgery and 34 (82.1%) received chemotherapy. Twenty-three patients were treated with at least two different types of therapy (56.1%). Actuarial 1 and 5 years survival were 77.8 and 71.2%, respectively. Early stage at presentation, surgery, normal lactic dehydrogenase (LDH) levels and good performance status were associated with longer survival in univariate analysis. Only normal LDH and good performance status retained their significance in multivariate analysis. Regarding disease-free survival in multivariate analysis, only normal LDH was associated with a better prognosis: 131 versus 12 months for LDH <197 and ≥197 mg/dl, respectively (P < 0.0001).

Conclusions

Optimal treatment of PGL remains controversial. High LDH levels and poor performance status at diagnosis are associated with shorter overall and disease-free survival and should be considered for the staging and management of these patients.

Keywords

Primary gastric lymphoma Prognostic factors Overall survival Disease free survival Lactic dehydrogenase (LDH) 

References

  1. 1.
    Al-Akwaa AM, Siddiqui N, Al-Mofleh IA. Primary gastric lymphoma. World J Gastroenterol 2004; 10:5–11PubMedGoogle Scholar
  2. 2.
    Nakamura S, Matsumoto T, Lida M, Yao T, Tsuneyoshi M. Primary gastrointestinal lymphoma in Japan: a clinicopathologic analysis of 455 patients with special reference to its time trends. Cancer 2003; 97:2462–2473PubMedCrossRefGoogle Scholar
  3. 3.
    Kodera Y, Yamamura Y, Nakamura S, et al. The role of radical gastrectomy with systematic lymphadenectomy for the diagnosis and treatment of primary gastric lymphoma. Ann Surg 1998; 227:45–50PubMedCrossRefGoogle Scholar
  4. 4.
    Ranaldi R, Goteri G, Baccarini MG, Mannello B, Bearzi I. A clinicopathological study of 152 surgically treated primary gastric lymphomas with survival analysis of 109 high grade tumours. J Clin Pathol 2002; 55:346–351PubMedGoogle Scholar
  5. 5.
    Koch P, del Valle F, Wolfgang B, et al. Primary Gastrointestinal non-Hodgkin’s lymphoma: I. Anatomic and histologic distribution, clinical features, and survival data of 371 patients registered in the German Multicenter Study GIT NHL 01/92. J Clin Oncol 2001; 19:3861–3873PubMedGoogle Scholar
  6. 6.
    Seydel J, Ullrich A, Bender R, Fischbach W, Blettner M. Helicobacter pylori and carcinogenesis of gastic B-cell lymphomas. Int J Cancer 2003; 104:646–649PubMedCrossRefGoogle Scholar
  7. 7.
    Yoon SS, Coit DG, Portlock CS, Karpeh MS. The diminishing role of surgery in the treatment of gastric lymphoma. Ann Surg 2004; 240:28–37PubMedCrossRefGoogle Scholar
  8. 8.
    Chen LT, Lin JT, Shyu RY, et al. Prospective study of Helicobacter pylori eradication therapy in stage IE high-grade mucosa-associated lymphoid tissue lymphoma of the stomach. J Clin Oncol 2001; 19:4245–4251PubMedGoogle Scholar
  9. 9.
    Raderer M, Chott A, Drach J, Montalban C, et al. Chemotherapy for management of localized high-grade gastric B-cell lymphoma: how much is necessary? Ann Oncol 2002; 13:1094–1098PubMedCrossRefGoogle Scholar
  10. 10.
    Koch P, del Valle F, Wolfgang BE, et al. Primary gastrointestinal non-Hodgkin’s lymphoma: II. Combined surgical and conservative management only in localized gastric lymphoma—results of the prospective German Multicenter Study GIT NHL 01/92. J Clin Oncol 2001; 19:3874–3883PubMedGoogle Scholar
  11. 11.
    Bozer M, Eroglu A, Unal E, Eryavuz Y, Kocaoglu H, Demirici S. Survival after curative resection for stage IE and IIE primary gastric lymphoma. Hepatogastroenterology 2001; 48:1202–1205PubMedGoogle Scholar
  12. 12.
    Kelessis NG, Vassilopoulos PP, Bai MP, Agnantis NJ, Avital SR, Rosenthal RJ. Update of the role of surgery in the multimodal treatment of MALT gastric lymphomas. Anticancer Res 2002; 22:3457–3464PubMedGoogle Scholar
  13. 13.
    Brands F, Moing SP, Raab M. Treatment and prognosis of gastric lymphoma. Eur J Surg 1997; 163:803–813PubMedGoogle Scholar
  14. 14.
    Aviles A, Nambo JM, Neri N, et al. The role of surgery in primary gastric lymphoma: results of a controlled clinical trial. Ann Surg 2004; 240(1):44–50PubMedCrossRefGoogle Scholar
  15. 15.
    Stephens J, Smith J. Treatment of primary gastric lymphoma and gastric mucosa-associated lymphoid tissue lymphoma. J Am Coll Surg 1998; 187:312–320PubMedCrossRefGoogle Scholar
  16. 16.
    Harris NL, Jaffe ES, Diebold J, et al. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissued: report of the Clinical Advisory Committee Meeting—Ailie House, Virginia, November 1997. J Clin Oncol 1999; 17:3835–3849PubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2007

Authors and Affiliations

  • Heriberto Medina-Franco
    • 1
  • Santos Soto Germes
    • 1
  • Carmen Lome Maldonado
    • 2
  1. 1.Department of Surgery, Division of Surgical OncologyNational Institute of Medical Sciences and Nutrition “Salvador Zubiran” Mexico CityMexico
  2. 2.Department of PathologyNational Institute of Medical Sciences and Nutrition “Salvador Zubiran”Mexico CityMexico

Personalised recommendations