Background: Gastric lymphoma is one of the most common extranodal lymphomas. Stage I/II disease is commonly treated with chemotherapy with or without radiation (RT). Although the development of secondary gastric cancers after treatment is a concern, the risk is not well described, and the role of histologic subtype and treatment remain unclear.

Patients and Methods: TheSurveillance, Epidemiology and End Results (SEER) database was used to estimate cumulative incidence (CI) of secondary gastric cancer among adult (≥18 yrs) patients diagnosed with stage I/II gastric lymphoma between 1983 and 2014. We excluded patients who had history of gastric cancer prior to the diagnosis of lymphoma. Cumulative incidence (CI) of gastric cancer was calculated using competing risk regression analysis and death without having gastric cancer was defined as competing event.

Results: A total of 10,192 patients were diagnosed with stage I/II gastic lymphoma of whom we excluded 321 patients with prior gastric neoplasm and 258 patients diagnosed with gastric cancer concurrently with lymphoma. The median age of the patients was 69 years (range, 18-104). Marginal zone lymphoma (MZL, N=3,981) was the most common histology followed by diffuse large B-cell lymphoma (DLBCL, N=3,944). After a median follow up of 76 months (range: 0-381 months), 417 patients developed secondary gastric cancer, and 173 (41%) died of gastric cancer. The 5-year and 10-year CI of gastric cancer was 4.1% (95%CI: 3.7-4.6%) and 4.8% (95%CI: 4.3-5.2%), respectively, 87% of secondary gastric cancer was diagnosed within 5 years after diagnosis of gastric lymphoma (Figure A).

Patients with MZL had a higher risk of secondary gastric cancer compared to patients with DLBCL (SHR: 1.55, 95%CI: 1.26-1.92, Figure B). RT was associated with higher risk of second gastric cancer in earlier priod (1983-2000, SHR 2.06, 95%CI: 1.20-3.51) but not in recent period (2001-2014, SHR: 1.04, 95%CI: 0.81-1.34). RT for the treatment of gastric lymphoma was associated with significant longer overall survival for both patients with MZL (HR: 0.83, 95%CI: 0.74-0.92) and DLBCL (HR: 0.60, 95%CI: 0.53-0.69).

Summary: Patients with gastric lymphoma have a low risk of developing secondary gastric cancers, though patients with MZL have a higher risk than those with DLBCL. RT is associated with significantly longer survival without increasing risk of secondary gastric cancer.

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Disclosures

Westin: Kite Pharma: Membership on an entity's Board of Directors or advisory committees; Novartis Pharmaceuticals Corporation: Membership on an entity's Board of Directors or advisory committees; Apotex: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees. Neelapu: Merck: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Poseida Therapeutics, Inc: Research Funding; Cellectis Inc.: Research Funding; Bristol-Myers Squibb: Research Funding; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Kite Pharma: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Karus: Research Funding. Fanale: MERCK: Membership on an entity's Board of Directors or advisory committees, Research Funding; CELGENE: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; GENENTECH: Research Funding; AMGEN: Membership on an entity's Board of Directors or advisory committees; ONYX: Research Funding; MOLECULAR TEMPLATES: Research Funding; ADC THERAPEUTICS: Research Funding; SEATTLE GENETICS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; TAKEDA: Honoraria, Research Funding; BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Nastoupil: TG Therapeutics: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Abbvie: Honoraria, Research Funding; Gilead: Honoraria; Karus Therapeutics: Research Funding; Genentech: Honoraria, Research Funding; Celgene: Honoraria, Research Funding.

Topics:
gastric cancer, gastric lymphoma, radiation therapy, diffuse large b-cell lymphoma, lymphoma, chemotherapy regimen, follow-up, lymphoma, extranodal, marginal zone b-cell lymphoma, stomach neoplasms

Author notes

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Asterisk with author names denotes non-ASH members.

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© 2017 by The American Society of Hematology
2017
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