Therapeutic Comparison of Chemotherapy and Surgery for Early Stage Diffuse Large B-cell Gastric Lymphoma

Abstract

PurposeThe use of surgery versus stomach-preserving treatment for primary gastric lymphoma has caused controversy among doctors. This retrospective, single center study aims to evaluate the efficacy and benefit of stomach-preserving treatment against surgery for early stage diffuse large B-cell lymphoma of stomach.Materials and MethodsFrom August 1991 to January 2006, 43 cases of early-stage diffuse large B-cell gastric lymphoma were reviewed.ResultsEleven cases were treated with chemotherapy or chemotherapy plus radiation (CT ± RT), 17 were treated with surgery alone (OP), and 15 were treated with surgery plus adjuvant chemotherapy (OP + CT). The complete remission and response rates were 63.6% and 90.9% in those treated with CT ± RT (7 complete responders, 3 partial responders, 1 non-responder), 100% and 100% in those treated with OP, and 100% and 100% in those treated with OP + CT, respectively. Five-year overall survival rates were 85.7%, 87.5%, and 100% in those treated by CT ± RT, OP, and OP + CT, respectively (p = 0.76). The five-year disease free survival rates were 100%, 87.5% and 100% in those treated by CT ± RT, OP, and OP + CT, respectively (p = 0.99). There was no significant difference in overall survival and disease free survival between modalities. Even though there are no definite differences in the number of complications between those treated by CT ± RT or OP, these facts reflect little concern on complications after surgery.ConclusionIn preventing morbidity arising from early or late complications from surgery and promoting quality of life, chemotherapy should be a primary consideration for early stage diffuse large B-cell lymphoma of the stomach.

Retrospective analysis of primary gastric diffuse largeB-cell lymphoma: a single center study from Turkey

“…Median age at the time of diagnosis and presenting symptoms were compatible with the literature (3,4,19). In this study, female predominance was documented, which was consistent with reports from Far East countries although literature from western countries reported male predominance (4,5,12,13,(19)(20)(21).…”

“…In this study, female predominance was documented, which was consistent with reports from Far East countries although literature from western countries reported male predominance (4,5,12,13,(19)(20)(21).…”

Predictors and Long-Term Outcomes for Diffuse Large B-Cell Lymphoma (DLBCL) Patients Undergoing Surgery Prior to Systemic Therapy: A Nationwide Analysis

“…In another study, the five-year OS rates were 88% with surgery and 86% in patients treated with only chemotherapy (p=0.350) indicating that an operative approach was not advantageous [ 3 ]. These results were reproduced by others as well [ 4 - 6 ]. While not offering a significant survival advantage, significant morbidity associated with upfront surgery has been noticed especially when involving the GI tract.…”

“…While not offering a significant survival advantage, significant morbidity associated with upfront surgery has been noticed especially when involving the GI tract. These include complications such as anastomotic leakage, gastrointestinal bleeding from remnant stomach or anastomosis site, dumping syndrome, and issues with malabsorption [ 4 ]. Given the similar outcomes and the morbidity associated with surgery, these studies recommend against surgery upfront.…”

Nonmucosa-associated lymphoid tissue lymphomas of gastric and intestinal origin differ in their clinical features: A single institute experience

“…An operation is reserved simply for surgical complications or localized residual disease after first-line conservative treatment. 6,7 By contrast, the most appropriate treatment modality for intestinal lymphoma is still controversial. 8,9 Patients with MALT lymphoma were excluded from the study because of the individual treatment policy and natural course of MALT lymphomas.…”