Fischbach, W, Dragosics, B, Kolve-Goebeler, M E, Ohmann, C, Greiner, A, Yang, Q, Böhm, S, Verreet, P, Horstmann, O, Busch, M, Dühmke, E, Müller-Hermelink, H K, Wilms, K, Allinger, S, Bauer, P, Bauer, S, Bender, A, Brandstätter, G, Chott, A, Dittrich, C, Erhart, K, Eysselt, D, Ellersdorfer, H, Ferlitsch, A, Fridrik, M A, Gartner, A, Hausmaninger, M, Hinterberger, W, Hügel, K, Ilsinger, P, Jonaus, K, Judmaier, G, Karner, J, Kerstan, E, Knoflach, P, Lenz, K, Kandutsch, A, Lobmeyer, M, Michlmeier, H, Mach, H, Marosi, C, Ohlinger, W, Oprean, H, Pointer, H, Pont, J, Salabon, H, Samec, H J, Ulsperger, A, 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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