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Prognostic Factors in Primary Gastric Lymphoma

¹ Department of Surgery, Division of Surgical Oncology, National Institute of Medical Sciences and Nutrition "Salvador Zubiran", Vasco de Quiroga 15, Tlalpan, Mexico City, 14000, Mexico
² Department of Pathology, National Institute of Medical Sciences and Nutrition "Salvador Zubiran", Mexico City, Mexico

Correspondence: Address correspondence and reprint requests to: Heriberto Medina-Franco, MD.; E-mail: herimd{at}hotmail.com

Background: There is not a gold standard in the treatment of primary gastric lymphoma (PGL). This study aimed to establish prognostic factors that should be considered for the staging and management of this disease.

Methods: We retrospectively reviewed and analyzed the clinicopathological features of patients treated for PGL in a tertiary referral center in Mexico City in a 10-year period from 1990 through 2000. Staging was performed with the Ann-Arbor system. Overall and disease-free survivals were the primary endpoints.

Results: We identified 41 patients of which 19 (46.3%) were classified as large-cell lymphoma, 16 (39.0%) as low-grade MALT, and 6 (14.6%) patients as lymphoma unspecified. The series included 15 (36.6%) patients with stage IV disease. Twenty patients (48.8%) underwent surgery and 34 (82.1%) received chemotherapy. Twenty-three patients were treated with at least two different types of therapy (56.1%). Actuarial 1 and 5 years survival were 77.8 and 71.2%, respectively. Early stage at presentation, surgery, normal lactic dehydrogenase (LDH) levels and good performance status were associated with longer survival in univariate analysis. Only normal LDH and good performance status retained their significance in multivariate analysis. Regarding disease-free survival in multivariate analysis, only normal LDH was associated with a better prognosis: 131 versus 12 months for LDH <197 and 197 mg/dl, respectively (P < 0.0001).

Conclusions: Optimal treatment of PGL remains controversial. High LDH levels and poor performance status at diagnosis are associated with shorter overall and disease-free survival and should be considered for the staging and management of these patients.

Key Words: Primary gastric lymphoma • Prognostic factors • Overall survival • Disease free survival • Lactic dehydrogenase (LDH)