Primary gastric non-Hodgkin's lymphoma: Clinical features, management, andprognosis of 185 patients with diffuse large B-cell lymphoma

Background: Primary gastric non-Hodgkin's lymphoma (PG-NHL) is common in Sa udi Arabia. This has prompted the analysis of a large series of patients wi th PG-NHL having high-grade diffuse large B-cell lymphoma (DLCL) in order t o define the clinical features and outcome of this disease. Patients and methods: The data of all adult patients in the series with PG- NHL having DLCL histology were retrospectively reviewed. Patients were elig ible if they had biopsy-confirmed diagnoses obtained by endoscopy or follow ing laparotomy. Results: Over a 16-year period, 185 patients with DLCL PG-NHL were identifi ed and their data were reviewed. Patients had a median age of 54 years. In 53% of them only one initial therapeutic modality was given, while 47% were managed by a multi-modality approach. One hundred forty patients (76%), 19 (10%), and 26 (14%) attained complete remission (CR), partial remission, a nd no response/progressive disease, respectively. Multivariate analysis sho wed that poor performance status and advanced stage were negatively associa ted with the likelihood of attaining CR. Over a median follow-up of 54 mont hs, 118 (64%) of the patients were alive and disease-free, 17 (9%) were ali ve with evidence of disease, and the remaining 50 (27%) were dead. The proj ected 5-year and 10-year overall survivals (OS) (+/- SD) were 68% (+/- 4%) and 61% (+/- 6%), respectively. The Cox proportional hazards model identifi ed the same variables of response as adverse prognostic factors of survival . Using the influence of performance status, and stage, a prognostic index was constructed to recognize three prognostically distinctive risk categori es with overall survival proportions of 87%, 61%, and 45%, respectively. Th e unadjusted International Prognostic Index, however, failed to classify pa tients into prognostically meaningful risk strata. Of the 140 patients who achieved CR, the median disease-free survival (DFS) was not reached, but th e predicted 5- and 10-year DFS were 82% and 75%, respectively. A multivaria te analysis identified poor performance status as the only independent prog nostic covariate that adversely influenced DFS. Our analysis showed that co mpared with single-modality management, multi-modality strategy attained si gnificantly higher CR, and advantageous OS and DFS. Conclusions: This large series characterized the clinico-pathologic feature s and outcome of patients with DLCL PG-NHL. Performance status, and stage s ignificantly influenced patient outcome. A prognostic index was developed a nd it identified three prognostically distinctive risk groups; however, pro spective validation is warranted.