Primary gastrointestinal non-Hodgkin lymphoma in adults: clinicopathologic and survival characteristics [Primarni ne-Hodgkinov limfom probavnog sustava]

Radić-Krišto, Delfa and Planinc-Peraica, Ana and Ostojić, Slobodanka and Vrhovac, Radovan and Kardum-Skelin, Ika and Jakšić, Branimir (2010) Primary gastrointestinal non-Hodgkin lymphoma in adults: clinicopathologic and survival characteristics [Primarni ne-Hodgkinov limfom probavnog sustava]. Collegium Antropologicum, 34 (2). pp. 413-417. ISSN 0350-6134

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Abstract

Primary non-Hodgkin lymphomas of gastrointestinal tract (PGI-NHL) are the most common extranodal lymphomas with an increasing incidence. The incidence, clinicopathologic characteristics, treatment and survival were assessed in 39 successive, newly diagnosed PGI-NHL patients (23 male and 16 female) treated at "Merkur" University Hospital. The aim of the study was to precisely evaluate their characteristics and compare them with the results reported from other similar studies. The most common site of PGI-NHL was stomach (n = 29, 74%), followed by small intestine (n = 5, 13%), and colon and rectosigmoid (n = 5, 13%). According to the Ann Arbor classification, 34 (87%) patients had stage IE and IIE, and five patients (12%) stage IIIE and IVE. According to World Health Organization (WHO) classification, 29 (87%) patients had diffuse large B-cell lymphoma (DLCBL), two had mantle cell lymphoma, and seven (18%) had marginal zone B-cell lymphoma-mucosa associated tissue (MALT). Twenty-six (66%) patients underwent surgical resection followed by chemotherapy, ten (26%) were treated with chemotherapy alone, and three (8%) were treated surgically. Complete remission was achieved in 28 (72%) and partial remission in seven (18%) patients. Four (10%) patients had progressive disease. In our patients, the major prognostic factor for outcome was the stage of disease. Patients with localized lymphoma (stage IE and IIE) had a significantly longer overall survival: 85% at five years and 65% at ten years. Patients with extended disease (stage IIIE and IVE) had overall survival less than 33%. The prognostic power of erythrocyte sedimentation rate (ESR), total protein, serum albumin, LDH concentration and activity was analyzed. Of these parameters, only LDH had a statistically significant effect on overall survival. In conclusion, our patient group was comparable to other literature reports on PGI-NHL patients according to clinicopathologic characteristics. Disease stage and LDH were the only parameters that had a statistically significant effect patient survival.

Abstract in Croatian

Primarni ne-Hodgkinov limfom (NHL) probavnog sustava najčešći je oblik ekstranodalnih limfoma s incidencijom rasta. U Kliničkoj bolnici »Merkur« retrospektivno smo analizirali 39 novodijagnosticiranih bolesnika (23 muškarca, 16 žena). Analizirali smo kliničko patološke karakteristike, način liječenja i preživljenje bolesnika u razdoblju od siječnja 1997. do siječnja 2007. godine. U 29 (74%) bolesnika dijagnosticiran je NHL želuca, u 5 (13%) tankog crijeva, a u 5 (13%) debelog crijeva. Klinički stadij bolesti odredili smo prema klasifikaciji Ann Arbor. Klinički stadij IE i IIE imalo je 34 (87%) bolesnika, dok je 5 (12%) bolesnika imalo stadij IIIE i IVE. Prema klasifikaciji Svjetske zdravstvene organizacije (SZO) 29 (87%) bolesnika imalo je B velikostanični limfom, 2 (5%) limfom plaštene zone, a 7 (18%) bolesnika imalo je limfom marginalne zone (MALT). Prema načinu liječenja 26 (66%) bolesnika liječeno je operacijski (potpuna ili djelomična gastrektomija ili resekcija) nakon čega su primali kemoterapiju, 10 (26%) bolesnika samo kemoterapijom, a 3 (8%) bolesnika samo operacijskim liječenjem. Kompletna remisija postignuta je u 28 (72%), djelomična remisija u 7 (18%) bolesnika, a u 4 (10%) bolesnika došlo je do progresije bolesti. Bolesnici s kliničkim stadijem IE i IIE imali su znatno duže preživljenje (5-godišnje preživljenje 85% bolesnika i 10-godišnje 65% bolesnika) od bolesnika u IIIE ili IVE stadiju bolesti koji su imali preživljenje manje od 33%. U studiji se analizirao i utjecaj ostalih parametara (dob, spol, SE, serumski albumini, ukupni proteini i laktat dehidrogenaza – LDH) na prognozu bolesnika. Jedini parametri koji su imali statistički značajan (p<0,05) utjecaj na preživljenje bili su stadij bolesti i vrijednost LDH.

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