PRIMARY GASTRIC LYMPHOMAS - A CLINICOPATHOLOGICAL STUDY WITH LITERATURE-REVIEW

Prognostic factors and treatment results were analysed in 28 consecuti ve patients with primary gastric lymphoma (PGL) diagnosed and treated, all by surgery and in many cases with additional chemotherapy (CT) an d/or radiotherapy (RT), between 1977 and 1988. There were 13 patients in stage I(E), 5 in II(E), and 10 in stage IV. The resection rate was 96.4% (27/28). Sixteen patients underwent an extended total and 11 a s ubtotal gastrectomy. Seventeen out of 25 cases (68%) were diagnosed by endoscopic biopsies. In 10 endoscopically diagnosed PGL cases the cli nical staging and separation between stages I(E) and II(E) from stage IV, due to ultrasonographic scan, computed tomography and bone marrow biopsy, was correct and the same with the surgical-pathological stagin g information. According to the Kiel-classification 18 patients had a low-grade and 9 patients a high-grade lymphoma. One patient could not be classified. All patients were completely followed-up, in an average time of 52 months. The probability of overall 5-year survival was 92% in stage I(E), 75% in stage II(E), 88% in stages I(E)+II(E) together, and 35% in stage IV. Extent of surgery (total vs. subtotal gastrectom y), Kiel-classification (low-grade vs. high-grade malignant histologic subtypes) and adjuvant CT in patients with stage I(E) (all 11 patient s without CT remain in complete remission after an average of 45 month s) did not significantly influence survival. The sole prognostic facto r with proven impact on survival was the stage of disease (I(E)+II(E) vs. IV: P=0.0001). For the Kiel-classification in particular there was no significant difference between low-grade and high-grade lymphomas with regard to the sex, symptomatic, extent of surgery, and stage at o peration. These findings, together with data from the literature, sugg est that gastric resection seems to be the optimal primary treatment i n clinically assessed stages I(E) or II(E). In patients with stage I(E ) disease, surgical resection can result in a cure, with no need for f urther therapy. The CT and/or RT can be effective in unresected and ev en bulky cases. Because of the difference in primary treatment, a preo perative clinical staging and separation between early stages from sta ge IV is always indicated.