Ben-Yosef R, Hoppe R T
Department of Radiation Oncology, Stanford University School of Medicine, California.
J Surg Oncol. 1994 Oct;57(2):78-86. doi: 10.1002/jso.2930570203.
The treatment of early-stage gastric lymphoma is controversial. This retrospective analysis reports on the outcome of 24 patients treated in our institution during the past 25 years. Fourteen patients had stage IEA, one patient had IEB, six patients IIEA1, and three patients had stage IIEA2 non-Hodgkin's lymphoma (NHL). Diffuse large cell intermediate-grade NHL was diagnosed in 17 patients, diffuse small cleaved cell in three patients, and diffuse mixed large and small cell lymphosarcoma, low-grade B-cell lymphoma, and unclassified lymphoma in one patient each. Fourteen patients underwent surgery, 21 had radiation therapy (XRT), and 10 patients received chemotherapy. Surgery + XRT were given to 7 patients, surgery + XRT + chemo and XRT alone were delivered to five patients each, and XRT + chemotherapy were employed in four patients. Surgery alone was the initial treatment in two patients and chemotherapy alone was given to one patient. Following treatment 22/24 achieved a complete response. During a mean follow-up period of 77.6 months (range 1-285), five patients relapsed. At 10 years, the actuarial survival of the 15 patients with stage I disease was 57.4% and for stage II it was 51.9% (Gehan P-value 0.33). Freedom from relapse (FFR) was 60.7% and 58.3%, respectively (P-value 0.56). No significant statistical differences in terms of survival and FFR were noted in patients treated with surgery, chemotherapy, or XRT. The outcome of patients treated with triple-modality therapy was similar to those treated with double-modality therapy and to patients treated with XRT alone. Gender, age, presenting symptoms, depth of tumor through the gastric wall, and stage were not statistically significant for prediction of either survival or FFR. Both surgery + XRT and chemotherapy + XRT are effective in the treatment of early-stage gastric disease. XRT alone is equally effective as two or three modality treatments in the subset of patients with early-stage gastric lymphoma. However, the low number of patients treated with various approaches over a long period precludes a firm conclusion. Until prospective randomized studies are initiated, management programs should be individually tailored.
早期胃淋巴瘤的治疗存在争议。本回顾性分析报告了过去25年在我院接受治疗的24例患者的治疗结果。14例患者为IEA期，1例为IEB期，6例为IIEA1期，3例为IIEA2期非霍奇金淋巴瘤（NHL）。17例患者被诊断为弥漫性大细胞中级NHL，3例为弥漫性小裂细胞型，1例分别为弥漫性大小细胞混合性淋巴肉瘤、低级别B细胞淋巴瘤和未分类淋巴瘤。14例患者接受了手术，21例接受了放射治疗（XRT），10例患者接受了化疗。7例患者接受了手术+XRT，5例患者分别接受了手术+XRT+化疗和单纯XRT，4例患者采用了XRT+化疗。2例患者最初仅接受了手术治疗，1例患者仅接受了化疗。治疗后22/24例患者达到完全缓解。在平均77.6个月（范围1-285个月）的随访期内，5例患者复发。10年时，15例I期疾病患者的精算生存率为57.4%，II期为51.9%（Gehan P值0.33）。无复发生存率（FFR）分别为60.7%和58.3%（P值0.56）。在接受手术、化疗或XRT治疗的患者中，在生存率和FFR方面未观察到显著的统计学差异。接受三联疗法治疗的患者的结果与接受双联疗法治疗的患者以及仅接受XRT治疗的患者相似。性别、年龄、表现症状、肿瘤穿透胃壁的深度和分期对生存率或FFR的预测均无统计学意义。手术+XRT和化疗+XRT在早期胃疾病的治疗中均有效。在早期胃淋巴瘤患者亚组中，单纯XRT与两联或三联疗法同样有效。然而，长期采用各种方法治疗的患者数量较少，无法得出确切结论。在开展前瞻性随机研究之前，管理方案应个体化定制。
