Prognostic factors in primary gastrointestinal non-Hodgkin's lymphoma. A multivariate analysis, report of 106 cases, and review of the literature

Abstract

The authors have reviewed 106 cases of primary gastrointestinal non-Hodgkin's lymphoma (GI-NHL) treated at the Institut Gustave-Roussy (IGR), France, between 1975 and 1986. The occurrence was 55 in the stomach, 26 in the small intestine, ten ileocecal, seven in the large intestine, and eight patients had multiple involvement. Patients were clinically staged according to the Ann Arbor staging system using the modification of Musshoff for Stage IIE. All histologic material of the 106 patients were reviewed and graded according to the Working Formulation (WF) and the Kiel classifications. Most patients received combination chemotherapy as part or all of their primary treatment program (95 patients, 90%). Seventy five patients (71%) had a multimodality treatment. The overall 5-year survival rate was 60%. Sixteen variables were tested by univariate analyses for prognostic influence on survival. Of these, only clinical stage (P less than 0.001), the achievement of initial complete remission (CR) (P less than 0.001), erythrocyte sedimentation rate (ESR) (P = 0.01), mesenteric involvement (P = 0.03), and serosal infiltration (P = 0.05) were significant prognostic factors. Important variables were tested by a multivariate analysis using the Cox model taking into account different treatment modalities. Only three variables entered the regression analysis at a significant level: clinical stage (P = 0.02), surgical resection (P = 0.03), and histologic grade (Kiel) (P = 0.04). When the achievement of initial CR was introduced into the model, it was the most significant variable (P less than 0.001) whereas all other variables became nonsignificant except for the histologic grade (Kiel) (P = 0.004). Based on results of the multivariate analyses we propose two prognostic classifications of patients: one at the initial evaluation depending on clinical stage, surgical resectability, and histologic grade (Kiel); the other at the end of primary treatment depending on the achievement or not of CR and the histologic grade.

Primary gastrointestinal lymphoma in Japan

“…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.…”

“…To our knowledge, 11 English studies performed a mul- tivariate analysis for prognostic factors on patients with both gastric and intestinal lymphoma. 9,[11][12][13][14][15][16]18,19,22,24 All but one 15 demonstrated an early stage to be the most significant prognostic factor for better survival. 9,[11][12][13][14]16,18,19,22,24 The next most frequent independent prognostic factor was a younger age.…”

“…9,[11][12][13][14][15][16]18,19,22,24 All but one 15 demonstrated an early stage to be the most significant prognostic factor for better survival. 9,[11][12][13][14]16,18,19,22,24 The next most frequent independent prognostic factor was a younger age. 11,15,16,18,24 Other factors reported to have contributed to survival included female gender, 11,12,22 surgical resection, 13,14,18 low-grade histology, 12,13,24 smaller size of tumor, 15,24 and a good performance status.…”

“…9,[11][12][13][14]16,18,19,22,24 The next most frequent independent prognostic factor was a younger age. 11,15,16,18,24 Other factors reported to have contributed to survival included female gender, 11,12,22 surgical resection, 13,14,18 low-grade histology, 12,13,24 smaller size of tumor, 15,24 and a good performance status. 15,22 Anatomic site (gastric localization) was an independent prognostic factor in two studies.…”

“…The role of surgery in the treatment of gastrointestinal lymphoma has been a matter of debate. [13][14][15][16][17][18]30,31,45,46 Although past studies showed that surgical resectability was of significance, recent studies have demonstrated that nonsurgical strategies and surgery-based modalities had an equivalent efficacy. 30,31,45 Based on all these observations, and taking patients' quality of life into consideration, nonsurgical treatment is an alternative and optimal therapeutic modality for gastrointestinal lymphoma.…”