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/microbiologyABSTRACT
A review is presented in this paper of the available diagnostic methods for the assessment of gastrointestinal function. The techniques of gastric secretion analysis, pancreatic secretion investigation and small intestinal absorption tests are described and discussed.
