Non-Hodgkin's lymphoma of the gastrointestinal tract: a population-based analysis of incidence, geographic distribution, clinicopathologic presentation features, and prognosis. Danish Lymphoma Study Group.

Abstract

(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.

Primary gastrointestinal lymphoma in Japan

“…As found in our study, d'Amore et al 23 demonstrated that patients with combined gastric and intestinal involvement showed a significantly poorer survival than patients with the involvement localized in the stomach or in the intestine. Similar results were reported by Ruskoné-Fourmestraux et al 18 and Koch et al 25 The poor prognosis of the combined group in our study may have been associated with more frequent T-cell phenotype and more advanced-stage disease.…”

“…However, most of these studies analyzed a small number of subjects and only five recruited more than 300 patients. 2,17,[23][24][25] The current study is the second largest series, which follows an earlier study by Freeman et al 2 Table 6 shows the primary site of gastrointestinal lymphoma in five studies, 2,17,[23][24][25] together with a larger population-based report by Gurney et al 37 The most common primary site was the stomach with a frequency ranging from 44% to 75%. In our series, the gastric group comprised 75% of all patients.…”

“…Similar results were reported by Ruskoné-Fourmestraux et al 18 and Koch et al 25 The poor prognosis of the combined group in our study may have been associated with more frequent T-cell phenotype and more advanced-stage disease. In three studies, 18,23,25 however, T-cell lymphomas were extremely rare. This discrepancy may correlate with the difference in the incidence of T-cell lymphoma between Western countries and Japan.…”

“…2,23,24,37 Geographic variations in the prevalence of H. pylori infection, celiac disease, or other environmental factors may be the cause of the difference. 35,38,39 In Middle Eastern countries, the frequency of intestinal lymphoma is high (range, 49 -81%).…”

“…A better prognosis for gastric lymphoma compared with other localizations has been described previously, 1,4,8,11,17,18,21,24,25 although several authors showed no difference in the prognosis between gastric lymphoma and intestinal lymphoma. 5,9,[13][14][15]19,20,22,23 Few publications have shown prognostic data on patients with both gastric and intestinal involvement.…”