Localised extranodal non-Hodgkin's lymphoma of the gastrointestinal tract:Sheffield Lymphoma Group experience (1989-1998)

Extranodal non-Hodgkin's lymphoma (NHL) of the gastrointestinal tract accou nts fur about one third of all extranodal NHL. We retrospectively reviewed the clinical and histopathologic records of 71 patients with stage IE acid IIE primary gastrointestinal NHL referred to the Sheffield Lymphoma Group ( SLG) From 1989 to 1998. Crossreferencing with the Hospital Histopathology D epartment database revealed that only two-thirds of all cases were seen by the Group. The most common primary site was the stomach (45 patients, 63% o f all cases), followed by the small intestine (16, 23%) and large intestine (9, 13%). The median age of patients was 62 years; the majority of patient s presented with stage I(61%) and/or 'high' grade (65%) NHL. Mucosa-associa ted lymphoid tissue (MALT) lymphomas were the largest histologic subtype se en (57%), with 87% of these arising from the stomach; next most frequent wa s the diffuse large B-cell subtype (21% of all cases) most frequently arisi ng from the intestine (60%). For treatment of gastric MALT lymphoma, a comb ined approach (surgery followed by chemotherapy, antihelicobacter therapy f ollowed by chemotherapy) was favoured (22 cases). Five-year and 10-year ove rall survivals were 52% and 45% respectively. Knowledge of the Revised Euro pean American Lymphoma classification and the Helicobacter pylori/MALT asso ciation has influenced treatment approaches over the 10-year study period. For small intestinal lymphoma, surgery (with or without chemotherapy) gave 5- and 10-year survivals of 60%. Overall survival of patients with primary gastrointestinal lymphoma managed by the SLG is similar to that reported fr om other large series.