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

被引:176
作者
Fischbach, W
Dragosics, B
Kolve-Goebeler, ME
Ohmann, C
Greiner, A
Yang, Q
Böhm, S
Verreet, P
Horstmann, O
Busch, M
Dühmke, E
Müller-Hermelink, HK
Wilms, K
机构
[1] Klinikum Aschaffenburg, Med Klin 2, D-63739 Aschaffenburg, Germany
[2] Gesundheitszentrum Wien Sud WKGG, Vienna, Austria
[3] Univ Wurzburg, Med Poliklin, D-8700 Wurzburg, Germany
[4] Univ Wurzburg, Dept Pathol, D-8700 Wurzburg, Germany
[5] Univ Dusseldorf, Coordinating Ctr Clin Trials, D-4000 Dusseldorf, Germany
[6] Univ Dusseldorf, Dept Surg, D-4000 Dusseldorf, Germany
[7] Univ Gottingen, Dept Surg, D-3400 Gottingen, Germany
[8] Univ Munich, Dept Radiotherapy & Radiooncol, Munich, Germany
[9] Univ Marburg, Zentrum Innere Med, D-3550 Marburg, Germany
关键词
D O I
10.1053/gast.2000.19579
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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 rish-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 EI) 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.
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页码:1191 / 1202
页数:12
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