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

The optimal treatment of localized large‐cell lymphoma of the stomach remains controversial. In particular, the role of surgical resection of the primary tumor needs to be clearly defined. We have reviewed all patients with a diagnosis of gastric lymphoma and treated in our institutions between 1988 and 1998. Patients fulfilling the following criteria were 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. All pertinent 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). Of group A, among 36 patients who could be evaluated for response to chemotherapy, there were 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 the other 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 of group A. Our data suggest that systemic chemotherapy alone may be a reasonable alternative treatment for stage I/II large‐cell lymphoma of the stomach. Resection of the primary tumor before systemic chemotherapy does not appear to improve the cure rate of this group of patients. Am. J. Hematol. 64:175–179, 2000. © 2000 Wiley‐Liss, Inc.