Chemotherapy alone versus surgery followed by chemotherapy for stage I/IIE large-cell lymphoma of the stomach

Division of Cancer Research, National Health Research Institutes, Taipei, TaiwanThe optimal treatment of localized large-cell lymphoma of the stomach remains contro-versial. In particular, the role of surgical resection of the primary tumor needs to beclearly defined. We have reviewed all patients with a diagnosis of gastric lymphoma andtreated in our institutions between 1988 and 1998. Patients fulfilling the following criteriawere included in this study: (1) histologically proven large-cell lymphoma of the stomach;(2) adequate pathological materials and complete clinical information for analysis; (3)clinical stage I/II disease according to the Musshoff modification of Ann Arbor system;and (4) received primary chemotherapy alone with anthracycline- or anthracenedione-containing regimens (group A) or curative surgery followed by adjuvant chemotherapy(group B). There were 38 and 21 patients in group A and group B, respectively. Allpertinent clinicopathologic features were similar between the two groups of patients,except that patients of group A had significantly more stage II-2 disease (P= 0.004). Ofgroup A, among 36 patients who could be evaluated for response to chemotherapy, therewere 29 complete and 1 partial responses, with an overall response rate of 83.3% (95% CI,71.1–95.5%). The projected 5-year relapse-free survival (RFS) and overall survival (OS)were 86.0% (95% CI, 73.3–98.7%) and 72.6% (95% CI, 57.0–88.2%), respectively. On theother hand, the projected 5-year RFS and OS of group B were 77.9% (95% CI, 58.0–97.8%)and 77.8% (95% CI, 57.9–97.7%), respectively, not significantly different from that ofgroup A. Our data suggest that systemic chemotherapy alone may be a reasonablealternative treatment for stage I/II large-cell lymphoma of the stomach. Resection of theprimary tumor before systemic chemotherapy does not appear to improve the cure rateof this group of patients. Am. J. Hematol. 64:175–179, 2000.