Primary Gastric Lymphoma: Conservative Treatment Modality Is Not Inferior to Surgery for Early-Stage Disease

Abstract

Objectives. The aim of this study was to evaluate clinical characteristics, prognostic factors, survival rates, and treatment modalities in patients with primary gastric lymphoma (PGL). Methods. We retrospectively reviewed and analyzed data from patients treated for PGL in our clinic from 1998 through 2010. Staging was performed using the Lugano Staging System. Overall and disease-free survival (OS and DFS) were calculated from the date of diagnosis. Results. We identified 79 patients. Thirty-seven patients (47%) were male. The median age at presentation was 57 (18–85) years. The median follow-up time was 41 (9–52) months. Thirty patients (38%) underwent surgery, 74 (92%) received chemotherapy, and 18 (23%) received radiotherapy. The five-year OS and DFS rates were 91.2% and 83.9%, respectively, in patients with stage I/II or IIE disease and 70.6% and 65.5%, respectively, in patients with stage IV disease (P = 0.02 for both rates). Treatment modality (surgical or conservative) had no impact on OS or DFS in early stages. In a multivariate analysis, poor performance status, advanced stage, and high LDH levels were significant bad prognostic factors for DFS, while advanced stage, poor performance status, and age > 60 years were significant bad prognostic factors for OS. Conclusion. Surgery provides no advantage for survival over conservative treatment; thus, conservative treatment modalities should be preferred initially at early stages of PGL.

Clinicopathological Features, Treatment Strategy, and Prognosis of Primary Non-Hodgkin’s Lymphoma of the Duodenum: A SEER Database Analysis

“…Meanwhile, multivariate analysis confirmed that the treatment modality was unrelated to DSS; that is, surgical treatment did not bring a survival advantage. e results were similar to previous reports (Table 4) [28][29][30][31] that the survival results of nonsurgical treatment were similar or even better than those of surgical treatment. Surgery, thus, is restricted to the treatment of complications such as occlusion, bleeding or perforation.…”

Localized primary gastrointestinal diffuse large B cell lymphoma received a surgical approach: an analysis of prognostic factors and comparison of staging systems in 101 patients from a single institution

“…The factors in favor of a surgical approach include the removal of primary lesions, availability of precise histological classification and staging, as well as avoidance of complications such as perforation or hemorrhage that may occur during radiotherapy and chemotherapy [ 4 – 6 ]. In the recent years, opinion has increasingly swung toward non-invasive treatment even for patients with resectable disease, so as to maintain their quality of life [ 7 – 9 ]. However, the benefit of a surgical approach remains controversial in the patients treated with Rituximab and chemotherapy/radiotherapy.…”

A Case Report of a Metastatic Primary Gastric Lymphoma; Diffuse Large B-Cell or Burkitt Lymphoma?

“…Staging of the PG-DLBCL is performed by consideration of the imaging studies, as well as bone marrow aspiration and biopsy. According to the Lugano staging, DLBCL stage I is limited to the GI tract, stage II is extended to the abdomen, stage IIE is defined as adjacent tissue involvement by serosa penetration, and stage IV disseminates to extra-nodal regions or is concomitant supra-diaphragmatic nodal involvement [7,8]. The international prognostic index (IPI) in case of PGL is calculated considering the following factors: age > 60 years, increased serum LDH, performance status ≥ 2, more than one extra-nodal involvement excluding the stomach, and stage III-IV of the disease [9].…”