Abstract
-
Objectives
- There is still no consensus on the optimal treatment for primary gastrointestinal lymphoma (PGIL). The aim of this study was to compare surgery combined with chemotherapy and chemotherapy alone in PGIL.
-
Methods
- We retrospectively reviewed and analyzed the treatment outcomes of 107 patients with primary gastrointestinal lymphoma diagnosed between March 1999 and December 2009 at Kosin University Gospel Hospital. Patients were divided into two groups: 35 patients who underwent surgery combined with chemotherapy (group A) and 72 patients who were treated with chemotherapy alone (group B). And we analyzed prognostic factors associated with short survival.
-
Results
- The 5-year progression free survival rates (PFS) of group A and B were 86.7% and 66.1%, respectively (P = 0.037), while the 5-year overall survival rates (OS) were 86.8% and 68.4%, respectively (P = 0.129). In multivariate analysis, Both PFS and OS were not changed by treatment strategies (surgery combined with chemotherapy or chemotherapy only). The international prognostic index (IPI) was the only independent predictive factor for PFS.
-
Conclusions
- In our study, surgery combined with chemotherapy and chemotherapy only make no difference of survival rate. And further randomized prospective studies are needed to confirm a treatment strategies at improving survival outcomes in PGIL patients.
-
Keywords: Chemotherapy; Primary gastrointestinal lymphoma; Surgery
Figure 1.Progression free survival rates compared in patients according to the treatment strategy. Patients treated with surgery combined with chemotherapy were shown had superior 5-year progression free survival rates than chemotherapy only in patients with primary gastrointestinal lymphoma. (P = 0.037)
Figure 2.Overall survival rates compared in patients according to the treatment strategy. There was no significant difference in 5-year overall survival rates between patients with primary gastrointestinal lymphoma treated with surgery combined with chemotherapy and chemotherapy only in patients with primary gastrointestinal lymphoma. (P = 0.129)
Table 1.The classification of PGIL according to Ann-Arbor staging system
I |
Involvement of a single lymph node region (I) or a single extralymphatic organ or site (IE) |
II |
Involvement of two or more lymph node regions on the same side of the diaphragm (II) or of an extralymphatic organ and its adjoining lymph node site (IIE) |
III |
Involvement of lymph node sites o both sides of the diaphragm (III) or localized involvement of an extralymphatic site (IIIE), spleen (IIIS), or both (IIISE) |
IV |
Diffuse or disseminated involvement of one or more extralymphatic organs with or without associated lymph node involvement |
Table 2Patient characteristics (N=107)
Characteristics/Category |
Number(%) |
Age, years |
|
Median (range) |
56 (21–79) |
Sex |
|
Male |
53 (49.5) |
Female |
54 (50.5) |
Histologic type |
|
Diffuse large B cell lymphoma |
69 (64.5) |
Marginal zone B cell lymphoma |
28 (26.2) |
Peripheral T cell lymphoma |
6 (5.6) |
Other B cell lymphoma |
4 (3.7) |
Gastrointestinal tract involved site |
|
Stomach |
68 (63.6) |
Small intestine |
26 (24.3) |
Colon |
13 (12.1) |
Ann Arbor Stage |
|
IE |
29 (27.1) |
IIE |
33 (30.8) |
IIIE |
25 (23.4) |
IV |
20 (18.7) |
Bone marrow involvement |
|
Present |
5 (4.7) |
No |
102 (95.3) |
LDH |
|
< 450 IU/L |
74 (69.2) |
≥ 450 IU/L |
33 (30.8) |
ECOG performance status |
|
0–1 |
67 (62.6) |
≥2 |
40 (37.4) |
IPI risk, |
|
Low |
48 (44.9) |
Low intermediate |
20 (18.7) |
High intermediate |
12 (11.2) |
High |
27 (25.2) |
Treatment |
|
Surgery+ Chemotherapy group |
35 (32.7) |
Chemotherapy group |
72 (67.3) |
Rituximab |
|
Yes |
33 (30.8) |
No |
74 (69.2) |
Table 3Comparison of patients based on a treatment strategy
|
Surgery+ Chemotherapy group (n=35) |
Chemotherapy group (n= 72) |
P-value |
Age, years < 60 |
23 (65.7) |
45 (62.5) |
0.746 |
≥ 60 |
12 (34.3) |
27 (37.5) |
|
Sex Male |
16 (45.7) |
37 (51.4) |
0.582 |
Female |
19 (54.3) |
35 (48.6) |
|
Histology |
|
|
|
DLBCL |
23 (65.7) |
46 (63.9) |
0.790 |
MZL |
8 (22.9) |
20 (27.8) |
|
Others |
4 (11.4) |
6 (8.3) |
|
Gastrointestinal tract involved site |
|
|
|
Stomach |
14 (40.0) |
54 (75.0) |
0.685 |
Small intestine |
16 (45.7) |
10 (13.9) |
|
Colon |
5 (14.3) |
8 (11.1) |
|
Ann Arbor Stage |
|
|
|
IE |
11 (31.4) |
18 (25.0) |
0.001 |
IIE |
18 (51.4) |
15 (20.8) |
|
IIIE |
5 (14.3) |
20 (27.8) |
|
IV |
1 (2.9) |
19 (26.4) |
|
Tumor size |
|
|
|
< 10 cm |
19 (79.2) |
37 (80.4) |
0.900 |
≥ 10 cm |
5 (20.8) |
9 (19.6) |
|
Bone marrow involvement |
|
|
|
Present |
0 (0.0) |
5 (6.9) |
0.110 |
No |
35 (100.0) |
67 (93.1) |
|
LDH |
|
|
|
< 450 IU/L |
26 (74.3) |
48 (66.7) |
0.423 |
≥ 450 IU/L |
9 (25.7) |
24 (33.3) |
|
ECOG performance status |
|
|
|
0–1 |
22 (62.9) |
45 (62.5) |
0.971 |
≥2 |
13 (37.1) |
27 (37.5) |
|
IPI risk |
|
|
|
Low |
19 (54.3) |
29 (40.3) |
0.432 |
Low intermediate |
7 (20.0) |
13 (18.1) |
|
High intermediate |
3 (8.6) |
9 (12.5) |
|
High |
6 (17.1) |
21 (29.2) |
|
Rituximab |
|
|
|
Yes |
8 (22.9) |
25 (34.7) |
0.212 |
No |
27 (77.1) |
47 (65.3) |
|
Table 4Univariate analysis of prognostic factors
|
5-year PFS (%) |
p-value |
5-year OS (%) |
p-value |
Age, years |
|
|
|
0.205 |
< 60 |
79.7 |
0.54 |
79.7 |
≥ 60 |
58.7 |
|
63.8 |
Sex |
|
|
|
0.879 |
Male |
72.8 |
0.677 |
76.1 |
Female |
73.7 |
|
73.7 |
Histology |
|
|
|
0.011 |
DLBCL |
78.8 |
0.094 |
78.8 |
MZL |
71.9 |
|
78.0 |
Others |
44.4 |
|
44.4 |
|
GI involve site Stomach Small intestine Colon |
69.5 57.0 71.6 |
0.167 |
74.5 58.0 67.7 |
0.096 |
Ann Arbor Stage |
|
|
|
0.026 |
IE and IIE |
83.3 |
0.002 |
83.3 |
IIIE and IV |
56.5 |
|
60.3 |
Tumor size |
|
|
|
0.155 |
< 10 cm |
73.5 |
0.161 |
77.1 |
≥ 10 cm |
55.5 |
|
55.0 |
Bone marrow involvement |
|
|
|
0.408 |
Present |
53.3 |
0.522 |
53.3 |
No |
74.3 |
|
75.8 |
LDH |
|
|
|
< 0.001 |
< 450 IU/L |
80.7 |
0.016 |
82.6 |
≥ 450 IU/L |
52.6 |
|
52.1 |
ECOG performance status |
|
|
|
0.158 |
0–1 |
78.9 |
0.016 |
79.0 |
≥2 |
62.7 |
|
67.0 |
IPI risk |
|
|
|
< 0.001 |
Low and Low intermediate |
84.3 |
< 0.001 |
84.4 |
High intermediate and High |
50.3 |
|
54.6 |
Treatment |
|
|
|
0.129 |
Surgery + Chemotherapy group |
86.7 |
0.037 |
86.8 |
Chemotherapy group |
66.1 |
|
68.4 |
Rituximab |
|
|
|
0.475 |
Yes |
81.2 |
0.118 |
76.7 |
No |
62.9 |
|
68.8 |
Table 5.Multivariate analysis of prognostic factors
|
PFS |
OS |
RR |
95% C.I. |
p-value |
RR |
95% C.I. |
p-value |
Histology DLBCL MZL Others |
|
|
|
0.516 |
0.140–1.907 |
0.321 |
Ann Arbor Stage (%) IE and IIE IIIE and IV |
0.918 |
0.321–2.631 |
0.874 |
0.576 |
0.214–1.549 |
0.274 |
LDH < 450 IU/L ≥ 450 IU/L |
0.828 |
0.364–1.881 |
0.652 |
0.447 |
0.181–1.104 |
0.081 |
ECOG performance status 0–1 ≥2 |
1.339 |
0.519–3.449 |
0.546 |
|
|
|
IPI risk Low and Low intermediate High intermediate and High |
0.184 |
0.058–0.583 |
0.004 |
0.503 |
0.168–1.504 |
0.219 |
Treatment Surgery + Chemotherapy group Chemotherapy group |
0.446 |
0.149–1.332 |
0.148 |
|
|
|
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