Primary gastric B-Cell lymphoma: Results of a prospective multicenter study

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 119; no. 5; pp. 1191 - 1202
• Main Authors: Fischbach, Wolfgang, Dragosics, Brigitte, Kolve–Goebeler, Maria–Elisabeth, Ohmann, Christian, Greiner, Axel, Yang, Qin, Böhm, Stephan, Verreet, Patrick, Horstmann, Olaf, Busch, Martin, Dühmke, Eckhart, Müller–Hermelink, Hans–Konrad, Wilms, Klaus
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-11-2000; Elsevier
• Subjects: Biological and medical sciences; Gastroenterology. Liver. Pancreas. Abdomen; Medical sciences; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors; HIV; REAL; MALT; Histological grading; Human; Stomach; Prognosis; Multicenter study; Clinical form; Malignant hemopathy; Malignancy; Genetic determinism; Lymphoma; Pathology; B-Cell; Lymphoproliferative syndrome; Primary; Digestive diseases; Strategy; Application method; Decision criterion; Gastric disease
• ISSN: 0016-5085; 1528-0012
• DOI: 10.1053/gast.2000.19579

Background & Aims: Appropriate management of primary gastric lymphoma is controversial. This prospective, multicenter study aimed to evaluate the accuracy of endoscopic biopsy diagnosis and clinical staging procedures and assess a treatment strategy based on Helicobacter pylori status and tumor stage and grade. Methods: Of 266 patients with primary gastric B-cell lymphoma, 236 with stages EI (n = 151) or EII (n = 85) were included in an intention-to-treat analysis. Patients with H. pylori–positive stage EI low-grade lymphoma underwent eradication therapy. Nonresponders and patients with stage EII low-grade lymphoma underwent gastric surgery. Depending on the residual tumor status and predefined risk factors, patients received either radiotherapy or no further treatment. Patients with high-grade lymphoma underwent surgery and chemotherapy at stages EI/EII, complemented by radiation in case of incomplete resection. Results: Endoscopic-bioptic typing and grading and clinical staging were accurate to 73% and 70%, respectively, based on the histopathology of resected specimens. The overall 2-year survival rates for low-grade lymphoma did not differ in the risk-adjusted treatment groups, ranging from 89% to 96%. In high-grade lymphoma, patients with complete resection or microscopic tumor residuals had significantly better survival rates (88% for EI and 83% for EII) than those with macroscopic tumor residues (53%; P < 0.001). Conclusions: There is a considerable need for improvement in clinical diagnostic and staging procedures, especially with a view toward nonsurgical treatment. With the exception of eradication therapy in H. pylori–positive low-grade lymphoma of stage EI and the subgroup of locally advanced high-grade lymphoma, resection remains the treatment of choice. However, because there is an increasing trend toward stomach-conserving therapy, a randomized trial comparing cure of disease and quality of life with surgical and conservative treatment is needed.
GASTROENTEROLOGY 2000;119:1191-1202