The gastrointestinal tract is a common primary extranodal site for non
-Hodgkin's lymphoma. There is however no uniform consensus on its path
ological classification, clinical staging system and management. This
paper reports the experience in the management of 425 Chinese patients
with primary gastrointestinal lymphoma in Hong Kong from January 1975
to June 1993. There were 230 (54 per cent) males and 195 (46 per cent
) females. Their median age was 53 years. The primary sites were: the
esophagus in three (1 per cent), stomach in 238 (56 per cent), small i
ntestine in 131 (31 per cent) and large intestine in 53 (12 per cent).
According to the Working Formulation, there were 20 (4 . 7 per cent)
small lymphocytic, 10 (2 . 4 per cent) follicular small cleaved cell,
15 (3 . 5 per cent) follicular mixed, five (1 . 2 per cent) follicular
large cell, 40 (9 . 4 per cent) diffuse small cleaved cell, 50 (12 pe
r cent) diffuse mixed, 181 (43 per cent) diffuse large cell, 30(7 . 1
per cent) immunoblastic, five (1 . 2 per cent) lymphoblastic, 10 (2 .
4 per cent) diffuse small non-cleaved cell and 50 (14 per cent) unclas
sifiable lymphoma. Immunophenotyping was performed in 199 (47 per cent
) patients: 90 per cent B-cell, 7 per cent T-cell and 3 per cent uncer
tain. According to a Manchester system, 81 (19 per cent) patients had
stage I disease, 44 (10 per cent) stage II, 85 (20 per cent) stage III
and 215 (51 per cent) stage IV. B symptoms were present in 275 (65 pe
r cent) patients and bulky disease in 104 (25 per cent). Surgery follo
wed by chemotherapy was the mainstay of treatment. Of the 408 patients
treated, 63 per cent had a complete remission with relapse rate of 42
per cent. For those with complete remission, 47 per cent were free fr
om disease at 5 years. The overall median survival of all patients was
45 per cent at 5 years. Multivariate analysis revealed that significa
nt independent prognostic factors predicting better survival were youn
g age of <60 years, low grade histology, stage I and II disease and ab
sence of bulky tumour. For gastric lymphoma, aggressive surgery did no
t significantly improve their outcome. Chemotherapy appears to play an
important role in the management of gastrointestinal lymphoma. Better
classification of the primary gastrointestinal lymphoma and more refi
ned stratification of the patients according to the prognostic variabl
es may allow individualization of treatment. Prospective randomized st
udies are essential to define the relative roles of surgery, chemother
apy and radiotherapy.