Primary gastric non-Hodgkin's lymphoma in Chinese patients: clinical characteristics and prognostic factors

Jiajia Huang,Tongyu Lin,Zhiming Li,Xiaofei Sun,Yue Lv,Wenqi Jiang,Zhongzhen Guan,Huiqiang Huang,Ruihua Xu,Zhongjun Xia

doi:10.1186/1471-2407-10-358

Jiajia Huang, Tongyu Lin + Show 8 more

Open Access

https://doi.org/10.1186/1471-2407-10-358

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Abstract

BackgroundOptimal management and outcome of primary gastric lymphoma (PGL) have not been well defined in the rituximab era. This study aimed to analyze the clinical characteristics, prognostic factors, and roles of different treatment modalities in Chinese patients with PGL.MethodsThe clinicopathological features of 83 Chinese patients with PGL were retrospectively reviewed. Staging was performed according to the Lugano staging system for gastrointestinal non-Hodgkin's lymphoma.ResultsThe predominant pathologic subtype among Chinese patients with PGL in our study was diffuse large B cell lymphoma (DLBCL), followed by mucosa-associated lymphoid tissue (MALT) lymphoma. Among the 57 patients with gastric DLBCL, 20 patients (35.1%) were classified as the germinal center B cell-like (GCB) subtype and 37 patients (64.9%) as the non-GCB subtype. The 83 patients had a five-year overall survival (OS) and event-free survival (EFS) of 52% and 59%, respectively. Cox regression analysis showed that stage-modified international prognostic index (IPI) and performance status (PS) were independent predictors of survival. In the 67 B-cell lymphoma patients who received chemotherapy, 36 patients treated with rituximab (at least 3 cycles) had a mean OS of 72 months (95% CI 62-81) versus 62 months (95% CI 47-76) for patients without rituximab treatment (P = 0.021).ConclusionThe proportion of Chinese gastric DLBCL cases with non-GCB subtype was higher than the GCB subtype. Stage-modified IPI and PS were effective prognostic factors in Chinese patients with PGL. Our data suggested that primary gastric B-cell lymphoma might have an improved outcome with rituximab in addition to chemotherapy. More studies are necessary, preferentially large prospective randomized clinical trials to obtain more information on the impact of the rituximab in the primary gastric B-cell lymphoma.

Highlights

Optimal management and outcome of primary gastric lymphoma (PGL) have not been well defined in the rituximab era
We found that performance status (PS) ≥ 2 (RR: 7.45, 95% CI 2.96-18.73, P < 0.0001), stage-modified international prognostic index (IPI) ≥ 2 (RR: 3.63, 95%CI 1.518.72, P = 0.004) and low hemoglobin (RR: 2.38, 95%CI 1.08-5.27, P = 0.032) were effective predictors of event-free survival (EFS) in Cox multivariate analysis
We found that the mean overall survival for patients treated with chemotherapy alone was 58 months

Summary

Introduction

Optimal management and outcome of primary gastric lymphoma (PGL) have not been well defined in the rituximab era. This study aimed to analyze the clinical characteristics, prognostic factors, and roles of different treatment modalities in Chinese patients with PGL. Primary gastric lymphoma (PGL) originates in the stomach, with or without perigastric and/or abdominal lymph node involvement [1]. Gastrectomy was the front-line treatment in patients with PGL. Recent clinical trial results supported that organ preservation with chemotherapy combined with radiation could yield equal results to surgery combined with radiation in PGL patients [11]. We decided to contribute to this field by investigating the clinical characteristics, prognostic factors, and the roles of different treatment modalities of PGL in the rituximab era

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