Anatomic Distribution, Clinical Features, and Survival Data of 87 Cases Primary Gastrointestinal Lymphoma

Background: The purpose of this study is to analyze the anatomic distribution, clinical features, therapeutic methods, and prognosis factors of primary gastrointestinal lymphoma (PGIL).

Methods: Clinical data of 87 cases PGIL in the First Affiliated Hospital of Dalian Medical University from January 1999 to December 2010 were collected. Follow-ups were made according to the clinical feature, pathological pattern, clinical stage, and therapeutic method. Kapan Meier method was used for the survival analysis. Log-rank test was used to perform univariate survival analysis. COX multivariate analysis was carried out to analyze factors of P < 0.05 in univariate survival analysis.

Results: The incidence of PGIL significantly increased in patients more than 40 years old (87.4%). Clinical symptoms of PGIL were indistinguishable from other digestive system diseases, which included abdominal pain or discomfort (72.4%), lack of appetite (16.3%), gastrointestinal hemorrhage (14.9%), and diarrhea (12.8%). Some patients presented with systemic symptoms or complications, such as weight loss (35.6%) and digestive tract obstruction (13.8%). Primary gastric lymphoma (PGL) was the most common, followed by primary intestine lymphoma (PIL). The majority of PGIL were single lesion, which included 40 cases (87%) PGL and 35 cases (94.5%) PIL. The most frequent site of PGL was antrum of the stomach (43.5%), as to PIL, the small intestine (90.2%) was the most frequent site, especially within 100 cm far away from ileocecal valve. Most of PGIL were derived from B cell (93.1%). The most common pathological type was mucosa-associated lymphoid tissue (MALT) (67.4%) in the PGL group and diffuse large B cell lymphoma (DLBCL) (46.3%) in the PIL group. Surgical treatment had been performed in most of PGIL, which included 32 cases in the PGL group and 38 cases in the PIL group. The 1-year overall survival (OS) and the 3-year OS were 82 and 77%, respectively. Analysis of single factor affecting prognosis showed that lesion location, sources of cells, and clinical stage were associated with OS. PGL group had better OS than that of PIL group (1-year 89 vs 62%, 3-year 84 vs 50%, P = 0.03). B cell-originated group had better OS than that of T cell-originated group (1-year 89 vs 36%, 3-year 85 vs 0 %, P = 0.008). Stage I + II group had better OS than that of stage III + IV group (1-year 89 vs 38%, 3-year 87 vs 0 %, P = 0.007). Multivariate analysis showed that clinical stage and sources of cells were the significant independent prognostic factors.

Conclusions: It was more common to find location of PGIL in the stomach than that in the intestine. The most common pathological type was MALT in the PGL and DLBCL in the PIL. The treatment of PGL was focused on chemotherapy. It was noting that since PIL was not only difficult to make confirmed diagnosis but also likely to develop with complications, so it was usually needed surgical excision. Clinical stage and pathological pattern were related to prognosis of PGIL.