Gastric non-Hodgkin's lymphoma: Analysis of 252 patients from a multicenter study

Aims and background: The stomach is the most common site of primary extrano dal non-Hodgkin's lymphoma (NHL) and no agreement has been reached so far o n the best therapeutic approach, The main objects of this study were to rep ort the long-term results and to evaluate the importance of some possible p rognostic factors in a large series of patients. NHL was considered primary gastric if the main symptoms at presentation were those of gastric disease . Methods and study design: We analyzed 252 consecutive patients treated betw een 1980 and 1993 in five hospitals in north-east Italy, According to the W orking Formulation, 98 patients had low grade lymphoma, 59 intermediate gra de D to Fl, 81 G or high grade and 14 were not classified, The patients wer e divided into two groups: one including patients with limited dis ease (lo calized to the stomach or perigastric lymph nodes: 165 patients) and one in cluding those with advanced disease (87 patients). The treatment consisted of surgery, chemotherapy, radiotherapy or combinations of these. Sixteen pa tients received only supportive therapy. Results: The five-year overall survival was 65.4%: 80.3% for patients with limited disease and 36.7% for those with advanced disease (P < 0,0001). Amo ng the limited disease patients the five-year survival was 84.4% for those treated with gastrectomy alone and 88,7% for those who received also adjuva nt chemotherapy (P = 0.11), However, while chemotherapy did not improve sur vival in low grade NHL, it seemed to produce a better survival in the inter mediate and high grade groups (P = 0,06). Twelve patients were treated with primary chemotherapy and the five-year survival was 71.2%. In multivariate regression analysis the most important variable for overall survival was s urgery for the whole group of 252 patients (P < 0,0001), while it was age f or the group with limited disease (P = 0.0008). Conclusions: Surgery alone can be curative for most patients with gastric l ymphoma limited to the stomach or to the perigastric lymph nodes; surgery f ollowed by chemotherapy seems to produce better results than surgery alone in intermediate and high grade lymphomas, Also a non-surgical approach with first-line chemotherapy is associated with a high rate of Complete remissi ons and five year survival. In advanced disease the five-year survival is s imilar to that of nodal NHL.