d'Amore F, Brincker H, Grønbaek K, Thorling K, Pedersen M, Jensen M K, Andersen E, Pedersen N T, Mortensen L S
Department of Haematology, Odense University Hospital, Denmark.
J Clin Oncol. 1994 Aug;12(8):1673-84. doi: 10.1200/JCO.1994.12.8.1673.
To evaluate incidence, time trends, geographic distribution, clinicopathologic presentation features, and prognostic factors for survival and relapse in gastrointestinal (GI) non-Hodgkin's lymphomas (NHLs).
Over a 9-year period (1983 to 1991), 2,446 new NHL cases were recorded in a Danish population-based NHL registry (Danish Lymphoma Study Group [LYFO]). Of these, 306 (12.5%) were GI NHL (175 gastric, 109 intestinal, and 22 both sites). LYFO registry data were used for incidence rate (IR) assessment, and time-trend and geographic distribution analysis. Relative risk (RR) values for survival and relapse were identified by multivariate analysis.
The mean annual, age-standardized IRs for gastric and intestinal NHL were 0.71/10(5) and 0.48/10(5) per year, respectively. Age-specific IRs for both localizations showed an exponential increase as a function of age. Time-trend analysis for the period 1983 to 1991 showed stable IRs for both localizations. Intestinal NHL was more frequent in males (male-to-female ratio, 2.0 v 1.3), and had a higher occurrence of disseminated disease, constitutional symptoms, high-grade histology, and T-cell phenotype (10% v 2%). Gastric NHL had more low-grade cases (38% v 19%), and almost all were of the mucosa-associated lymphoid tissue (MALT) type. The cause-specific 5-year survival rate was 63% for gastric NHL and 49% for intestinal NHL. The Musshoff staging system was an excellent discriminator between truly localized (stage I and II1) and disseminated cases (stage II2 to IV), particularly for gastric NHL, for which no survival difference was found between surgically and conservatively stage localized cases.
(1) No increase in the incidence of GI NHL was found over a 9-year observation period; (2) nonrandom spatial distribution of new GI NHL cases was observed; (3) factors that significantly increased the risk of death in gastric cases were presence of B symptoms (RR = 3.3), clinical stage is more than II1 (RR = 3.0), age more than 72 years (RR = 2.4), and elevated serum lactate dehydrogenase (s-LDH) level (RR = 2.0); and factors that increased the risk of death in intestinal cases were presence of B symptoms (RR = 3.2), age more than 58 years (RR = 2.8), and clinical stage more than I (RR = 2.1); (4) factors that significantly increased the risk of relapse in gastric cases were male sex and no radiotherapy in primary treatment; and in intestinal cases were T-cell phenotype and no surgery in primary treatment; (5) surgical staging, as opposed to thorough noninvasive staging, did not improve staging accuracy and final outcome in localized gastric NHL.
评估胃肠道非霍奇金淋巴瘤（NHL）的发病率、时间趋势、地理分布、临床病理表现特征以及生存和复发的预后因素。
在9年期间（1983年至1991年），丹麦基于人群的NHL登记处（丹麦淋巴瘤研究组[LYFO]）记录了2446例新的NHL病例。其中，306例（12.5%）为胃肠道NHL（175例胃，109例肠道，22例为两个部位均有病变）。LYFO登记处的数据用于发病率（IR）评估、时间趋势和地理分布分析。通过多变量分析确定生存和复发的相对风险（RR）值。
胃和肠道NHL的年龄标准化年均发病率分别为每年0.71/10⁵和0.48/10⁵。两个部位的年龄特异性发病率均随年龄呈指数增长。1983年至1991年期间的时间趋势分析显示，两个部位的发病率均保持稳定。肠道NHL在男性中更为常见（男女比例为2.0比1.3），播散性疾病、全身症状、高级别组织学和T细胞表型的发生率更高（10%比2%）。胃NHL的低级别病例更多（38%比19%），且几乎均为黏膜相关淋巴组织（MALT）型。胃NHL的病因特异性5年生存率为63%，肠道NHL为49%。Musshoff分期系统在真正局限性（I期和II1期）和播散性病例（II2期至IV期）之间是一个很好的区分指标，特别是对于胃NHL，手术分期和保守分期的局限性病例之间未发现生存差异。
（1）在9年观察期内未发现胃肠道NHL发病率增加；（2）观察到新的胃肠道NHL病例存在非随机空间分布；（3）胃病例中显著增加死亡风险的因素为存在B症状（RR = 3.3）、临床分期超过II1期（RR = 3.0）、年龄超过72岁（RR = 2.4）以及血清乳酸脱氢酶（s-LDH）水平升高（RR = 2.0）；肠道病例中增加死亡风险的因素为存在B症状（RR = 3.2）、年龄超过58岁（RR = 2.8）以及临床分期超过I期（RR = 2.1）；（4）胃病例中显著增加复发风险的因素为男性和初始治疗未进行放疗；肠道病例中为T细胞表型和初始治疗未进行手术；（5）与全面的非侵入性分期相反，手术分期并未提高局限性胃NHL的分期准确性和最终结局。
