Primary lymphomas of the gastrointestinal tract

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Abstract
Clinicopathological factors affecting survival were analyzed in 60 primary gastrointestinal lymphomas. Patients with generalized lymphoma (Stages III and IV) at the time of diagnosis and those without follow-up information or adequate histological material were excluded. Lymphomas were classified according to the Lukes-Collins, Kiel and Rappaport schemes, and the patients were staged retrospectively by a modified Ann Arbor system. Patients were treated by surgical resection and/or radiotherapy. Survival was influenced by histological type (P = 0.0116), stage of the disease (P < 0.0001) and size of the primary tumor (P = 0.0007). Low-grade lymphoplasmacytoid lymphomas, recognized in 26.6% of the cases, had a low rate of extra-abdominal recurrence; 74% of these patients were alive without evidence of recurrence after a median follow-up of 171 mo., or died without evidence of lymphoma with a median survival of 147 mo. Centrocytic (Kiel) or cleaved cell (Lukes-Collins) types were seen in 13 and 21%, and high grade (Kiel) or large noncleaved and immunoblastic (Lukes-Collins) in 33.3 and 30% of the cases, respectively. These groups had a high rate of extra-abdominal recurrences, and over 60% of the patients died of lymphoma, with a median survival of 8 for the centroblastic-centrocytic and 7 mo. for the high-grade tumors. Histological type and clinicopathological staging emerge as useful factors for the identification of patients with high risk of systemic recurrence, probably best treated with chemotherapy in addition to surgery and local radiotherapy.