Increased risk of gastric adenocarcinoma after treatment of primary gastric diffuse large B-cell lymphoma

Abstract

BackgroundThere have been sporadic reports about synchronous as well as metachronous gastric adenocarcinoma and primary gastric lymphoma. Many reports have dealt with metachronous gastric adenocarcinoma in mucosa-associated lymphoid tissue lymphoma of stomach. But to our knowledge, there have been no reports that document the increased incidence of metachronous gastric adenocarcinoma in patients with gastric diffuse large B-cell lymphoma. This retrospective study was conducted to estimate the incidence of metachronous gastric adenocarcinoma after primary gastric lymphoma treatment, especially in diffuse large B-cell lymphoma.MethodsThe retrospective cohort study of 139 primary gastric lymphoma patients treated with radiotherapy at our hospital. Mean observation period was 61.5 months (range: 3.7-124.6 months). Patients profile, characteristics of primary gastric lymphoma and metachronous gastric adenocarcinoma were retrieved from medical records. The risk of metachronous gastric adenocarcinoma was compared with the risk of gastric adenocarcinoma in Japanese population.ResultsThere were 10 (7.2%) metachronous gastric adenocarcinoma patients after treatment of primary gastric lymphomas. It was quite high risk compared with the risk of gastric carcinoma in Japanese population of 54.7/100,000. Seven patients of 10 were diffuse large B-cell lymphoma and other 3 patients were mixed type of diffuse large B-cell lymphoma and mucosa associated lymphoid tissue lymphoma. Four patients of 10 metachronous gastric adenocarcinomas were signet-ring cell carcinoma and two patients died of gastric adenocarcinoma. Metachronous gastric adenocarcinoma may have a more malignant potential than sporadic gastric adenocarcinoma. Old age, Helicobacter pylori infection and gastric mucosal change of chronic gastritis and intestinal metaplasia were possible risk factors for metachronous gastric adenocarcinoma.ConclusionThere was an increased risk of gastric adenocarcinoma after treatment of primary gastric lymphoma, especially of diffuse large B-cell lymphoma.

Second Gastric Cancer After the Treatment of Primary Stomach Diffuse Large B-Cell Lymphoma

“…After radiotherapy for large B-cell lymphoma (Table 1) second gastric cancer occurs after a period of 4 to 15 years [13,[20][21][22]. This period was 11 years in our case.…”

“…The etiologic factors in these SPC is a young age at diagnosis, the combination of chemotherapy, the infection with Helicobacter pylori (HBP), the histological type of large cell lymphoma and the radiation therapy [1,4,[8][9][10][11][12][13].…”

“…In the NCI study, the risk of occurrence of an SPC is multiplied by 6 for patients with a first cancer diagnosed before the age of 18 years. It is multiplied by 2 to 3 for a first cancer diagnosed between 18 and 39 years, and 1.2 to 1.6 between 40 and 59 years [13].…”

“…Chemotherapy is not known to induce solid tumors, but can potentiate the effect of other treatments [8,14]. In a study of about 139 patients treated for gastric lymphoma, the authors found that CHOP type chemotherapy is associated with a higher risk of second gastric cancer (p=0.009) [13]. Further, it is possible that alkylating agents exert a mutagenic and carcinogenic effect [1,3,7,14].…”

Actual Management of Primary Gastric Lymphoma - An Interdisciplinary Approach

“…The check-up has to be done at least on an annual basis, for at least 10 years. We have to consider, at least in patients with atrophic gastric and/or intestinal metaplasia also the subsequent 6-fold increased risk of developing gastric adenocarcinoma (70).…”