Mehmet Kucukoner, Sener Cihan, Uyeturk Ummugul, Seker Mesut, Tastekin Didem, Tonyali Onder, Balakan Ozan, Yazici Omer Kemal, Urakci Zuhat, Isikdogan Abdurrahman, Ozdemir Nuriye, Inal Ali, Kaplan Muhammed Ali, Suner Ali, Dal Sinan, Uncu Dogan, Gumus Mahmut, Boruban Melih Cem, Oksuzoglu Berna, Ayyildiz Orhan, Benekli Mustafa
Dicle University, Medical Oncology Department, Turkey.
Ankara, Medical Oncology Department, Turkey.
Contemp Oncol (Pozn). 2014;18(4):273-8. doi: 10.5114/wo.2014.40556. Epub 2014 Jul 22.
Gastrointestinal lymphoma is the most common type of extranodal lymphoma and commonly involved site is the stomach. We have compared the superiority between treatment modalities for primary gastric lymphoma and we want to investigate efficacy of rituximab in gastric lymphoma.
Between April 2002 and December 2011, 146 patients with a histologically confirmed primary gastric lymphoma, initially diagnosed at eight different Cancer Centers within Turkey were evaluated retrospectively. According to the treatment modality, the patients were divided into chemotherapy (CT) alone, chemotherapy and radiotherapy (CRT), surgery and chemotherapy (SCT), surgery along with chemotherapy and radiotherapy (SCRT), and surgery (S) alone groups.
Median follow-up period was 25.5 months. The 5-year EFS (event free survival) and OS (overall survival) rates for the patients were 55% and 62.3% respectively. In Log rank analysis of OS and EFS, we have identified levels of albumin and hemoglobine, IPI score, stage at diagnosis as factors influencing survival. In multivariate analysis of OS and EFS, only albumin and stage at diagnosis were factors independently contributing to survival. There was no statistically significant difference in terms of survival between different treatment modalities (p = 0.707 in EFS and p = 0.124 in OS). In analysis of patients treated with chemotherapy alone, there was no a statistically significant difference in terms of EFS and OS between chemotherapy regimens with or without rituximab in localized and advanced stage groups (p = 0.264 and p = 0.639). There was no statistical difference in survival rate (EFS and OS) between surgical or non-surgical treatment modalities for localized/advanced stage gastric lymphoma groups (p = 0.519 / p = 0.165).
There are several treatment options due to similar results in different treatment modalities. Also benefit of rituximab treatment in gastric lymphoma is still a controversial subject. Additional prospective trials are definitely required in order to clarify use of rituximab in treatment of extranodal gastric lymphoma.
胃肠道淋巴瘤是最常见的结外淋巴瘤类型，最常累及的部位是胃。我们比较了原发性胃淋巴瘤不同治疗方式的优势，并想研究利妥昔单抗在胃淋巴瘤中的疗效。
回顾性评估了2002年4月至2011年12月期间在土耳其八个不同癌症中心初诊的146例经组织学确诊的原发性胃淋巴瘤患者。根据治疗方式，将患者分为单纯化疗（CT）组、化疗联合放疗（CRT）组、手术联合化疗（SCT）组、手术联合化疗及放疗（SCRT）组和单纯手术（S）组。
中位随访期为25.5个月。患者的5年无事件生存率（EFS）和总生存率（OS）分别为55%和62.3%。在OS和EFS的对数秩分析中，我们确定白蛋白和血红蛋白水平、国际预后指数（IPI）评分、诊断时的分期为影响生存的因素。在OS和EFS的多因素分析中，只有白蛋白和诊断时的分期是独立影响生存的因素。不同治疗方式之间的生存率无统计学显著差异（EFS中p = 0.707，OS中p = 0.124）。在单纯化疗患者的分析中，在局限性和晚期组中，含或不含利妥昔单抗的化疗方案之间的EFS和OS无统计学显著差异（p = 0.264和p = 0.639）。局限性/晚期胃淋巴瘤组手术或非手术治疗方式之间的生存率（EFS和OS）无统计学差异（p = 0.519 / p = 0.165）。
由于不同治疗方式的结果相似，有多种治疗选择。利妥昔单抗治疗在胃淋巴瘤中的益处仍是一个有争议的话题。为了阐明利妥昔单抗在结外胃淋巴瘤治疗中的应用，肯定需要更多的前瞻性试验。
