Objectives

Clinically, primary gastric diffuse large B cell lymphoma (PG-DLBCL) is not encountered commonly. The optimal treatment of PG-DLBCL remains controversial. Whether patients should receive surgical resection, Rituximab or not was most concerned about. Here we analized 83 patients with PG-DLBCL retrospectivly and evaluated the effect of surgical option and Rituximab in the treatment of PG-DLBCL.

Methods

From January 2009 to December 2014, 83 cases of PG-DLBCL patients in the First Affiliated Hospital of Soochow University were retrospectively studied. Forty cases received surgical resection plus chemotherapy (group A) and 43 patients underwent chemotherapy alone (group B). The operation mode is decided by the surgeon according to the patients¡¯ current condition and the chemotherapy regimens of two groups were CHOP or R-CHOP. Patients¡¯ characteristics were listed in Table 1. The main outcomes of overall survival (OS) and the progression free survival (PFS) were analized by using the Kaplan-Meier (K-M) method.

Results

The K-M analysis showed that the 3-year PFS and OS in group A were 66.7% and 68.4%, respectively. On the other hand, the 3-year PFS and OS of group B were 82.6%and 85.7%, respectively. There is no significant difference between the two groups. For patients received CHOP or R-CHOP, the 5-year OS were 77.7% and 78.2% (p=0.178). And the 3-year PFS were 74.9% and 75.5% (p=0.347). The difference between the two groups was not statistically significant. In group A, the 5-year PFS of R-CHOP group and CHOP group is 62.5% and 71.2% £¨p=0.747£©, the 5-year OS of R-CHOP group and CHOP group is 64.2% and 73.6% (p=0.853). In group B, the 5-year PFS of R-CHOP group and CHOP group is 83.4% and 81.8% £¨p=0.706£©, the 5-year OS of R-CHOP group and CHOP group is 85.7% and 83.5% (p=0.753). The univariate analyses indicated that age and lactate dehydrogenase (LDH) level were related to prognosis. Multivariate analysis of prognostic factors with a Cox model showed that IPI was the only independent prognostic factor.

Conclusions

This study shows that PG-DLBCL patients have a similar long-term survival rate when adopted surgery plus chemotherapy. Therefore, resection of the primary tumor before systemic chemotherapy does not improve the survival of the patients with PG-DLBCL. At the same time, the addition of Rituximab to chemotherapy doesn¡¯t make difference for the survival of PG-DLBCL. More prospective clinical trials about the effect of surgical operation and rituximab are needed to confirm the results of our study.

Table 1.

Patients¡¯ baseline characteristics

Patients £¨%£©P value
With surgical resection
(Group A, n£½40£© 		Without chemotherapy
(Group B, n £½ 43 £© 
Gender    
Male 19£¨47.5%£© 24£¨55.8%£© 0.449 
Female 21£¨52.5%£© 19£¨44.2%£©  
Age    
¡Ü60 15£¨37.5%£© 22£¨51.2%£© 0.211 
£¾60 25£¨62.5%£© 21£¨48.8%£©  
Ann Arbor    
Stage I/II 13£¨32.5%£© 7£¨16.3%£© 0.084 
Stage III/IV 27£¨67.5%£© 36£¨83.7%£©  
ECOG    
£¼2 19£¨47.5%£© 22£¨51.2%£© 0.739 
¡Ý2 21£¨52.5%£© 21£¨48.8%£©  
Treatment plan    
R-CHOP 23£¨57.5%£© 24£¨55.8%£© 0.887 
CHOP 17£¨42.5%£© 19£¨44.2%£©  
LDH    
¡Ü245 24£¨60.0%£© 27£¨62.8%£© 0.794 
£¾245 16£¨40.0%£© 16£¨37.2%£©  
IPI    
¡Ü2 13£¨32.5%£© 15£¨34.9%£© 0.818 
£¾2 27£¨67.5%£© 28£¨65.1%£©  
Patients £¨%£©P value
With surgical resection
(Group A, n£½40£© 		Without chemotherapy
(Group B, n £½ 43 £© 
Gender    
Male 19£¨47.5%£© 24£¨55.8%£© 0.449 
Female 21£¨52.5%£© 19£¨44.2%£©  
Age    
¡Ü60 15£¨37.5%£© 22£¨51.2%£© 0.211 
£¾60 25£¨62.5%£© 21£¨48.8%£©  
Ann Arbor    
Stage I/II 13£¨32.5%£© 7£¨16.3%£© 0.084 
Stage III/IV 27£¨67.5%£© 36£¨83.7%£©  
ECOG    
£¼2 19£¨47.5%£© 22£¨51.2%£© 0.739 
¡Ý2 21£¨52.5%£© 21£¨48.8%£©  
Treatment plan    
R-CHOP 23£¨57.5%£© 24£¨55.8%£© 0.887 
CHOP 17£¨42.5%£© 19£¨44.2%£©  
LDH    
¡Ü245 24£¨60.0%£© 27£¨62.8%£© 0.794 
£¾245 16£¨40.0%£© 16£¨37.2%£©  
IPI    
¡Ü2 13£¨32.5%£© 15£¨34.9%£© 0.818 
£¾2 27£¨67.5%£© 28£¨65.1%£©  

ECOG: Eastern Cooperative Oncology Group; CHOP: cyclophosphamide, doxorubicin, vincristine, prednisone; R-CHOP: rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone; LDH: lactate dehydrogenase

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Disclosures

No relevant conflicts of interest to declare.

Topics:
diffuse large b-cell lymphoma, excision, rituximab, cyclophosphamide, doxorubicin, prednisone, and vincristine, r-chop, chemotherapy regimen, surgical procedures, operative, cyclophosphamide, doxorubicin, lactate dehydrogenase

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2015 by The American Society of Hematology
2015
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