Ibrahim E M, Ezzat A A, Raja M A, Rahal M M, Ajarim D S, Mann B, Baloush A, Stuart R K, Bazarbashi S N
Department of Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
Ann Oncol. 1999 Dec;10(12):1441-9. doi: 10.1023/a:1008325823967.
Primary gastric non-Hodgkin's lymphoma (PG-NHL) is common in Saudi Arabia. This has prompted the analysis of a large series of patients with PG-NHL having high-grade diffuse large B-cell lymphoma (DLCL) in order to define the clinical features and outcome of this disease.
The data of all adult patients in the series with PG-NHL having DLCL histology were retrospectively reviewed. Patients were eligible if they had biopsy-confirmed diagnoses obtained by endoscopy or following laparotomy.
Over a 16-year period, 185 patients with DLCL PG-NHL were identified and their data were reviewed. Patients had a median age of 54 years. In 53% of them only one initial therapeutic modality was given, while 47% were managed by a multi-modality approach. One hundred forty patients (76%), 19 (10%), and 26 (14%) attained complete remission (CR), partial remission, and no response/progressive disease, respectively. Multivariate analysis showed that poor performance status and advanced stage were negatively associated with the likelihood of attaining CR. Over a median follow-up of 54 months, 118 (64%) of the patients were alive and disease-free, 17 (9%) were alive with evidence of disease, and the remaining 50 (27%) were dead. The projected 5-year and 10-year overall survivals (OS) (+/- SD) were 68% (+/- 4%) and 61% (+/- 6%), respectively. The Cox proportional hazards model identified the same variables of response as adverse prognostic factors of survival. Using the influence of performance status, and stage, a prognostic index was constructed to recognize three prognostically distinctive risk categories with overall survival proportions of 87%, 61%, and 45%, respectively. The unadjusted International Prognostic Index, however, failed to classify patients into prognostically meaningful risk strata. Of the 140 patients who achieved CR, the median disease-free survival (DFS) was not reached, but the predicted 5- and 10-year DFS were 82% and 75%, respectively. A multivariate analysis identified poor performance status as the only independent prognostic covariate that adversely influenced DFS. Our analysis showed that compared with single-modality management, multi-modality strategy attained significantly higher CR, and advantageous OS and DFS.
This large series characterized the clinico-pathologic features and outcome of patients with DLCL PG-NHL. Performance status, and stage significantly influenced patient outcome. A prognostic index was developed and it identified three prognostically distinctive risk groups; however, prospective validation is warranted.
原发性胃非霍奇金淋巴瘤（PG-NHL）在沙特阿拉伯很常见。这促使我们对一系列患有高级别弥漫性大B细胞淋巴瘤（DLCL）的PG-NHL患者进行分析，以明确该疾病的临床特征和预后。
回顾性分析该系列中所有组织学为DLCL的成年PG-NHL患者的数据。通过内镜检查或剖腹手术后经活检确诊的患者符合入选标准。
在16年期间，共识别出185例DLCL型PG-NHL患者并对其数据进行了回顾。患者的中位年龄为54岁。其中53%的患者仅接受了一种初始治疗方式，而47%的患者采用了多模式治疗方法。140例（76%）、19例（10%）和26例（14%）患者分别达到完全缓解（CR）、部分缓解和无反应/疾病进展。多因素分析显示，体能状态差和晚期与达到CR的可能性呈负相关。中位随访54个月后，118例（64%）患者存活且无疾病，17例（9%）患者存活但有疾病证据，其余50例（27%）患者死亡。预计的5年和10年总生存率（OS）（±标准差）分别为68%（±4%）和61%（±6%）。Cox比例风险模型确定了与反应相同的变量作为生存的不良预后因素。利用体能状态和分期的影响，构建了一个预后指数，以识别三个预后显著不同的风险类别，其总生存率分别为87%、61%和45%。然而，未经调整的国际预后指数未能将患者分为具有预后意义的风险分层。在140例达到CR的患者中，无病生存期（DFS）未达到中位值，但预计的5年和10年DFS分别为82%和75%。多因素分析确定体能状态差是唯一对DFS有不利影响的独立预后协变量。我们的分析表明，与单模式治疗相比，多模式策略获得了显著更高的CR率，以及有利的OS和DFS。
这个大样本系列研究描述了DLCL型PG-NHL患者的临床病理特征和预后。体能状态和分期显著影响患者预后。开发了一个预后指数，它识别出三个预后显著不同的风险组；然而，需要进行前瞻性验证。
