Primary gastric B-cell lymphoma: Results of a prospective multicenter study

Abstract

Background & Aims: Appropriate management of primary gastric lymphoma is controversial. This prospective, multicenter study aimed to evaluate the accuracy of endoscopie biopsy diagnosis and clinical staging procedures and assess a treatment strategy based on Helicobacter pylori status and tumor stage and grade. Methods: Of 266 patients with primary gastric B-cell lymphoma, 236 with stages El (n = 151) or Ell (n = 85) were included in an intention-to-treat analysis. Patients with H. py/or/-positive stage El low-grade lymphoma underwent eradication therapy. Nonresponders and patients with stage Ell low-grade lymphoma underwent gastric surgery. Depending on the residual tumor status and predefined risk factors, patients received either radiotherapy or no further treatment. Patients with highgrade lymphoma underwent surgery and chemotherapy at stages El/Ell, complemented by radiation in case of incomplete resection. Results: Endoscopic-bioptic typing and grading and clinical staging were accurate to 73% and 70%, respectively based on the histopathology of resected specimens. The overall 2-year survival rates for low-grade lymphoma did not differ in the risk-adjusted treatment groups, ranging from 89% to 96%. In highgrade lymphoma, patients with complete resection or microscopic tumor residuals had significantly better survival rates (88% fo' El and 83% for Ell) than those with macroscopic tumor residues (53%; P < 0.001). Conclusions: There is a considerable need for improvement in clinical diagnostic and staging procedures, especially with a view toward nonsurgical treatment. With the exception of eradication therapy in H. py/or/-positive low-grade lymphoma of stage El and the subgroup of locally advanced high-grade lymphoma, resection remains the treatment of choice. However, because there is an increasing trend toward stomach-conserving therapy, a randomized trial comparing cure of disease and quality of life with surgical and conservative treatment is needed. © 2000 by the American Gastroenterological Association.