Zinzani P L, Magagnoli M, Pagliani G, Bendandi M, Gherlinzoni F, Merla E, Salvucci M, Tura S
Institute of Hematology and Oncology Seràgnoli, University of Bologna, Italy.
Haematologica. 1997 May-Jun;82(3):305-8.
Lymphomas of the gastrointestinal tract are the most common type of primary extranodal lymphomas, accounting for 5 to 10% of all non-Hodgkin's lymphomas. In particular, primary intestinal lymphomas represent about 15-20% of gastrointestinal lymphomas. New multimodal therapeutic approaches have improved the prognosis of this once deadly disease: we report a retrospective analysis of our experience with 32 cases of primary western intestinal lymphomas, presenting clinical, therapeutical and prognostic data.
From March 1989 to November 1995, 32 patients with untreated primary western intestinal lymphomas were submitted to radical surgery plus polychemotherapy (early stages, I and II; 22 patients), or polychemotherapy alone (advanced stage, III and IV; 10 patients). The most frequent symptoms were abdominal pain, nausea, vomiting and weight loss. The tumor was located in the jejunum in 2 cases (6.2%), in the proximal small bowel in 15 cases (46.9%), in the distal and terminal ileum in 8 cases (25%), in the colon and rectum in 4 cases (12.5%), and multiple sites were found in 3 cases (9.4%). According to histology, 26 patients had high-grade and 6 low-grade non-Hodgkin's lymphoma.
Stage I-II patients underwent radical resection of the tumor and chemotherapy; advanced (III-IV) stage patients were treated with chemotherapy alone as first-line approach. Of the 32 patients, 24 (75%) achieved a complete response (CR); according to stage, all stage I-II patients had CR, while only 2 of the 10 stage III-IV patients reached CR. The risk of a lower response rate was significantly correlated with the presence of advanced stage (III-IV) (p = 0.000001). The overall 5-year survival rate was 59%, with a relapse-free survival rate of 72% among the 24 complete responders.
Intestinal lymphomas differ significantly from their gastric counterpart, not only in pathology, but also with regard to clinical features, management and prognosis. Our experience confirm the efficacy of the surgery-chemotherapy combination in obtaining a good remission rate for localized early primary intestinal lymphoma and indicates that this combination represents the only means for managing complications.
胃肠道淋巴瘤是最常见的原发性结外淋巴瘤类型，占所有非霍奇金淋巴瘤的5%至10%。特别是，原发性肠道淋巴瘤约占胃肠道淋巴瘤的15% - 20%。新的多模式治疗方法改善了这种曾经致命疾病的预后：我们报告了对32例原发性西方肠道淋巴瘤患者的经验进行的回顾性分析，呈现了临床、治疗和预后数据。
从1989年3月至1995年11月，32例未经治疗的原发性西方肠道淋巴瘤患者接受了根治性手术加联合化疗（早期，I期和II期；22例患者），或仅接受联合化疗（晚期，III期和IV期；10例患者）。最常见的症状是腹痛、恶心、呕吐和体重减轻。肿瘤位于空肠2例（6.2%），近端小肠15例（46.9%），远端和末端回肠8例（25%），结肠和直肠4例（12.5%），3例（9.4%）为多部位发病。根据组织学，26例患者为高级别非霍奇金淋巴瘤，6例为低级别非霍奇金淋巴瘤。
I - II期患者接受了肿瘤根治性切除和化疗；晚期（III - IV期）患者作为一线治疗仅接受化疗。32例患者中，24例（75%）达到完全缓解（CR）；根据分期，所有I - II期患者均达到CR，而10例III - IV期患者中只有2例达到CR。缓解率较低的风险与晚期（III - IV期）的存在显著相关（p = 0.000001）。总体5年生存率为59%，24例完全缓解者的无复发生存率为72%。
肠道淋巴瘤与其胃部对应物有显著差异，不仅在病理学方面，而且在临床特征、管理和预后方面。我们的经验证实了手术 - 化疗联合对于局部早期原发性肠道淋巴瘤获得良好缓解率的有效性，并表明这种联合是处理并发症的唯一手段。
