Fischbach, W und Dragosics, B und Kolve-Goebeler, M E und Ohmann, C und Greiner, A und Yang, Q und Böhm, S und Verreet, P und Horstmann, O und Busch, M und Dühmke, E und Müller-Hermelink, H K und Wilms, K und Allinger, S und Bauer, P und Bauer, S und Bender, A und Brandstätter, G und Chott, A und Dittrich, C und Erhart, K und Eysselt, D und Ellersdorfer, H und Ferlitsch, A und Fridrik, M A und Gartner, A und Hausmaninger, M und Hinterberger, W und Hügel, K und Ilsinger, P und Jonaus, K und Judmaier, G und Karner, J und Kerstan, E und Knoflach, P und Lenz, K und Kandutsch, A und Lobmeyer, M und Michlmeier, H und Mach, H und Marosi, C und Ohlinger, W und Oprean, H und Pointer, H und Pont, J und Salabon, H und Samec, H J und Ulsperger, A und Wimmer, A und Wewalka, F
(2000)
Primary gastric B-cell lymphoma: results of a prospective multicenter study. The German-Austrian Gastrointestinal Lymphoma Study Group.
Gastroenterology, 119 (5).
pp. 1191-202.
ISSN 0016-5085
Für diesen Eintrag wurde kein Volltext-Dokument angefügt.
Kurzfassung
BACKGROUND & AIMS
Appropriate management of primary gastric lymphoma is controversial. This prospective, multicenter study aimed to evaluate the accuracy of endoscopic 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 EI (n = 151) or EII (n = 85) were included in an intention-to-treat analysis. Patients with H. pylori-positive stage EI low-grade lymphoma underwent eradication therapy. Nonresponders and patients with stage EII 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 high-grade lymphoma underwent surgery and chemotherapy at stages EI/EII, 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 high-grade lymphoma, patients with complete resection or microscopic tumor residuals had significantly better survival rates (88% for EI and 83% for EII) 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. pylori-positive low-grade lymphoma of stage EI 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.
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