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Gastroenterology ; 119(5): 1191-202, 2000 Nov.
Article in English | MEDLINE | ID: mdl-11054376

ABSTRACT

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.


Subject(s)
Biopsy/methods , Biopsy/standards , Endoscopy/standards , Lymphoma, B-Cell/pathology , Lymphoma, B-Cell/therapy , Stomach Neoplasms/pathology , Stomach Neoplasms/therapy , Adult , Aged , Antineoplastic Agents/therapeutic use , Combined Modality Therapy , Gastrectomy , Helicobacter Infections/complications , Helicobacter pylori , Humans , Lymphoma, B-Cell/microbiology , Middle Aged , Neoplasm Staging/standards , Prospective Studies , Radiotherapy , Stomach Neoplasms/microbiology
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