Gastric non-Hodgkin's lymphomas: analysis of 252 patients. A multicenter study.

I.F.: 0,490 Aims and background: The stomach is the most common site of primary extranodal non-Hodgkin's lymphoma (NHL) and no agreement has been reached so far on the best therapeutic approach, The main objects of this study were to report the long-term results and to evaluate the importance of some possible prognostic factors in a large series of patients. NHL was considered primary gastric if the main symptoms at presentation were those of gastric disease. Methods and study design: We analyzed 252 consecutive patients treated between 1980 and 1993 in five hospitals in north-east Italy, According to the Working Formulation, 98 patients had low grade lymphoma, 59 intermediate grade D to Fl, 81 G or high grade and 14 were not classified, The patients were divided into two groups: one including patients with limited dis ease (localized to the stomach or perigastric lymph nodes: 165 patients) and one including those with advanced disease (87 patients). The treatment consisted of surgery, chemotherapy, radiotherapy or combinations of these. Sixteen patients received only supportive therapy. Results: The five-year overall survival was 65.4%: 80.3% for patients with limited disease and 36.7% for those with advanced disease (P < 0,0001). Among the limited disease patients the five-year survival was 84.4% for those treated with gastrectomy alone and 88,7% for those who received also adjuvant chemotherapy (P = 0.11), However, while chemotherapy did not improve survival in low grade NHL, it seemed to produce a better survival in the intermediate and high grade groups (P = 0,06). Twelve patients were treated with primary chemotherapy and the five-year survival was 71.2%. In multivariate regression analysis the most important variable for overall survival was surgery for the whole group of 252 patients (P < 0,0001), while it was age for the group with limited disease (P = 0.0008). Conclusions: Surgery alone can be curative for most patients with gastric lymphoma limited to the stomach or to the perigastric lymph nodes; surgery followed by chemotherapy seems to produce better results than surgery alone in intermediate and high grade lymphomas, Also a non-surgical approach with first-line chemotherapy is associated with a high rate of Complete remissions and five year survival. In advanced disease the five-year survival is similar to that of nodal NHL.