Primary Gastric Lymphoma:Clinicopathologic Review and Prognostic Factors

ABSTRACT

BACKGROUND: Primary gastric lymphoma is a rare neoplasm that represents 1~4% of all gastric malignancies. The optimal treatment of primary gastric lymphoma remains controversial. This study was designed to examine the prognostic significance of various clinicopathologic factors in patients with gastric lymphoma and to evaluate the role of surgery in the treatment of gastric lymphoma. METHODS: Retrospective study of 71 cases of primary gastric lymphoma which had been undergone laparotomy at the Department of Surgery, Seoul National University Hospital from Jan. 1982 to Dec. 1996 was performed. The authors reviewed clinicopathologic factors of patients and evaluated their prognostic significance. RESULTS: 1) The mean age of the patients was 50 years, and the most prevalent ages occurred in the 6th & the 7th decade. The ratio of males to females was 1.3:1. 2) The presenting symptoms and signs on admission were epigastric abdominal pain & discomfort, weight loss, anorexia, indigestion, and abdominal mass in decreasing order of frequency. 3) The diagnostic accuracy of the gastrofiberscopic biopsies was 67.1% preoperatively. 4) The most common pathologic type was diffuse histiocytic type (57.1%) in Rappaport classification, and diffuse large cell type (47.1%) in NCI Working formulation classification. 5) The distribution of stages according to modified TNM classification was 47.9% stage I, 36.6% stage II, 11.3% stage III, and 4.2% stage IV. 6) Overall, a potentially curative resection was performed in 92.9% of the cases. Treatment modalities included surgery (S), chemotherapy (CT), and radiotherapy (RT) in the following proportions: 33.8% only S, 53.5% S CT, 11.3% S RT, and 1.4% S CT RT. 7) The overall 5-year survival rate was 78.9%. The 5-year survival rates according to stage were 94.1% in stage I, 80.4% in stage II, 30.0% in stage III and 0% in stage IV.