Eser Bulent, Kaplan Bunyamin, Unal Ali, Canoz Ozlem, Altuntas Fevzi, Sari H Ismail, Er Ozlem, Ozkan Metin, Kucuk Can, Arar Makbule, Gursoy Sebnem, Cetin Mustafa
Department of Hematology-Oncology, Erciyes University School of Medicine, 38039 Kayseri, Turkey.
Yonsei Med J. 2006 Feb 28;47(1):22-33. doi: 10.3349/ymj.2006.47.1.22.
Primary gastrointestinal lymphoma is a common presentation of non-Hodgkin's lymphoma. The main controversy arises when many aspects of its classification and management are under discussion, particularly regarding roles for surgical resection. The aim of this study was to evaluate clinicopathologic characteristics and the therapeutic outcome of primary gastrointestinal non-Hodgkin's lymphoma. We carried out a retrospective analysis of 74 patients who were presented to our center with histopathological diagnosis of primary gastro-intestinal non-Hodgkin's lymphoma between 1990 and 2001. All patients have been staged according to Lugano Staging System. For histopathological classification, International Working Formulation was applied. The treatment choice concerning the surgical or non-surgical management was decided by the initially acting physician. Treatment modalities were compared using the parameters of age, sex, histopathological results, stage, and the site of disease. Of the 74 patients, 31 were female and 43 were male, with a median age of 49 years (range 15-80). The stomach was the most common primary site and was seen in 51 of 74 patients (68.9%). The intermediate and high grade lymphomas constituted 91.9% of the all cases. In a median follow-up of 29 months (range 2-128), 20 out of 74 patients died. There was a three year overall survival rate in 65.4% of all patients. The three year overall survival rate was better in stage I and II1 patients who were treated with surgery plus chemotherapy (+/-RT) than those treated with chemotherapy alone (93.7% vs. 55.6%, p < 0.05). The stage and presence of B symptoms affected the disease free survival and overall survival significantly, but the histopathologic grade only affected the overall survival. On the basis of these results, we suggest that surgical resection is necessary before chemotherapy in early stage (stage I and II1) patients with gastrointestinal non-Hodgkin's lymphomas because of the significant survival advantage it would bring to the patient.
原发性胃肠道淋巴瘤是非霍奇金淋巴瘤的常见表现形式。当对其分类和治疗的诸多方面进行讨论时，主要争议便会出现，尤其是关于手术切除的作用。本研究的目的是评估原发性胃肠道非霍奇金淋巴瘤的临床病理特征及治疗效果。我们对1990年至2001年间因原发性胃肠道非霍奇金淋巴瘤的组织病理学诊断而就诊于本中心的74例患者进行了回顾性分析。所有患者均根据卢加诺分期系统进行分期。对于组织病理学分类，采用国际工作方案。关于手术或非手术治疗的选择由首诊医生决定。使用年龄、性别、组织病理学结果、分期和疾病部位等参数对治疗方式进行比较。74例患者中，女性31例，男性43例，中位年龄49岁（范围15 - 80岁）。胃是最常见的原发部位，74例患者中有51例（68.9%）。中、高级别淋巴瘤占所有病例的91.9%。中位随访29个月（范围2 - 128个月），74例患者中有20例死亡。所有患者的三年总生存率为65.4%。接受手术加化疗（±放疗）治疗的Ⅰ期和Ⅱ1期患者的三年总生存率优于单纯接受化疗的患者（93.7%对55.6%，p < 0.05）。分期和B症状的存在对无病生存率和总生存率有显著影响，但组织病理学分级仅影响总生存率。基于这些结果，我们建议对于早期（Ⅰ期和Ⅱ1期）胃肠道非霍奇金淋巴瘤患者，在化疗前进行手术切除是必要的，因为这将给患者带来显著的生存优势。
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