Non-Hodgkin's lymphoma of the stomach: Treatment outcomes for 57 patients over a 20-year period

Background: Gastric non-Hodgkin's lymphoma (NHL) is a rare subtype of malignancy, for which no consensus exists about treatment. In this study, the treatment outcomes of gastric NHL in 57 patients were retrospectively evaluated for a period of 20 years at a single institute. Methods: Clinical stages were classified according to the Ann Arbor staging system: 29 patients were stage 1, 17 stage II, two stage III, and nine stage IV. The 46 stage I/II patients received aggressive, multimodal therapy: 24 of these (group A) were treated with surgery-based management, which included surgery alone (n = 6), surgery + chemotherapy (CT; n = 14), surgery + radiotherapy (RT; n = 2), and surgery + CT + RT (n = 2); 22 patients (group B) did not receive surgery, but received CT alone (n = 11), CT + RT (n = 5), or, in patients with low-grade mucosa-associated lymphoid tissue (MALT) lymphoma, an oral anti-Helicobacter pylori regimen (n = 6). The 11 stage III/IV patients received CT and/or RT with regimens similar to those for stage I/II patients. Results: Except for 1 patient with an initial surgical diagnosis, 56 patients underwent gastric endoscopic examination, which proved that 42 had NHL. The rate of diagnostic accuracy by gastroscopy was 75%. After multimodal treatment (n = 46) and a median follow-up of 54 months (range, 1-210 months), the 5-year survival rate was 40.3%. The 5-year survival rates for stage I, II and III/IV patients were 57.2%, 47% and 0%, respectively (p < 0.005). Of the 24 surgical patients (group A) who received sequential CT, with or without RT, 12 remained disease-free after a median follow-up of 98 months (range, 1-210 months); three patients died because of postoperative complications. Of the 22 non-surgical patients (group B) who received CT, alone or combined with RT, 14 remained disease-free after a median follow-up of 40 months (range, 4-189 months); 1 patient died because of massive gastric hemorrhage after CT. All stage III and IV patients died after a median survival of 4 months (range, 1-8 months). Conclusion: Clinical stage is the most important factor predicting the long-term survival of patients with gastric NHL. Surgery may still be necessary in cases of failed gastroscopic diagnosis. In early-stage gastric NHL, non-surgical treatment seems able to achieve the aims of improved long-term survival and, in some instances, cure.