Clinicopathologic Features and Prognostic Factors of Gastrointestinal Malignant Lymphoma

Ryu, Keun Won; Mok, Young Jae; Kim, Seung Joo; Kim, Chong Suk

Abstract

PURPOSE: The gastrointestinal tract (GI) is the most common site of extranodal non-Hodgkin's lymphoma (NHL), which is increasing in incidence, but the staging and the histologic classification of GI-NHL are still in debate. Furthermore, there is no established optimal treatment modality. Thus, we investigated the clinicohistologic features, the therapeutic modalities, and the prognosis for GI-NHL, as well as the factors affecting it. We also give a review of the literature.
METHODS
We retrospectively analyzed 67 patients who had been diagnosed as having GI-NHL and had been followed up from 1984 to 1999 at Korea University Medical Center Hospital. They were divided into groups according to the site of origin and to various other features, and the survivals of the various groups were compared. The modified Ann Arbor system and the international working formulation (IWF) were adopted for staging and histopathologic classification, respectively.
RESULTS
GI-NHL of the stomach, the small bowel, and the colon and rectum occurred in 35 patients (52.2%), 20 patients (29.9%), and 10 patients (14.9%), respectively. In two patients, the entire gastrointestinal tract was diffusely involved. The mean age of patients was 49.7+/-16.2 years, and the male-to-female ratio was 4.2:1. There was an tendency for young and male to have GI-NHL involving the lower gastrointestinal tract. Twenty-three (34.3%) patients was in stage I, 28 (41.8%) in stage II, 7 (10.4%) in stage III, and 9 (13.4%) in stage IV. Eight (11.9%) patients had a low IWF grade, 47 (70.1%) an intermediate grade, and 12 (17.9%) a high grade. The stage and the histologic classification did not vary with the original site. Surgical resection was performed in 50 (74.6%) patients, and chemotherapy was performed in 53 (79.1%) patients. The overall 5-yearsurvival rate of 67 patients was 49.9%, and there was a significant survival difference between the stages (p=0.0023), but not between sites of origin (p=0.9043). The most important factors influencing the survival was the stage; other factors were not significant.
CONCLUSION
The stomach was the most common site of GI-NHL. Most GI-NHLs were localized and of intermediate grade. Stage was the most important prognostic factor. However, prospective randomized studies are needed to approve the therapeutic modality.