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The primary gastric lymphoma: prognosis

Romeo Giuli MD, resident.
School of General and Emergency Surgery.
University of Siena.   Italy.

October 2001.     Review Article.

Kodera and colleagues underline that multivariate analysis reveals that curability of the operation followed by the histopathologic grade ( discrimination between LG and HG lesions by endoscopic biopsies alone does not always lead to an appropriate diagnosis) are significant indipendent prognostic factors.
Despite the larger tumor diameter, the depth of invasion for the low grade type is mostly submucosal, and none had serosal invasion. In contrast, 50% of the high grade type had serosal involvement and were also found to have a higher incidence of nodal metastasis ( 1 ).

Vaillant and colleagues agree that complete resection is a major determinant of prolonged complete remission ( 2 ).

Rodriguez-Sanjuan and colleagues affirm that serosa involvement and high grade tumors adversely influence survival but gastrectomy type, resection margin invasion, and postoperative chemotherapy do not appear to have any influence ( 3 ).
The presence of histologic features of MALToma in patients with primary large cell gastric lymphoma might have been associated with a better response to systemic chemotherapy and a better prognosis ( 4 ).

Analysis of the gene expression offers the surgeon the capability to understand the biology of these tumors and to predict their behavior. Such information is useful when choosing therapeutic protocols because it identifies the aggressive tumors.
The Charalambous and colleagues study shows that bax gene expression, as determined by routine histochemical methods, is a prognostic variable for patients with primary gastric lymphoma. Statistically significant interactions are observed between bax and bcl-2 immunostaining data with regard to clinical outcome. Increased P53 protein expression seems to characterize high grade gastric lymphomas ( 5 ).


1) Y Kodera et al. Primary gastric B cell lymphoma : audit of 82 cases treated with surgery and classified according to the concept of mucosa-associated lymphoid tissue lymphoma. World J Surg. 24, 857-862, 2000.

2) Jean-Christophe Vaillant et al. Management and long-term results of Surgery for localized gastric lymphomas. The American Journal of Surgery. 2000; 179: 216-222.

3) JC Rodriguez-Sanjuan et al. Results and prognostic factors in Stage I E - II E primary gastric lymphoma after gastrectomy. J Am Coll Surg 1999; 188: 296-303.

4) Chiun Hsu et al. Comparison of MALT and non-MALT primary large cell lymphoma of the stomach. Cancer 2001; 91: 49-56.

5)G K Charalamous et al. Protein expression of bax, bcl-2 and p53 in patients with non-Hodgkin's gastric lymphoma: prognostic significance.World J Surg, 24, 608-614, 2000.

6) Z D Aydin and colleagues. Gastric lymphomas in Turkey. Cancer 2000; 89: 12-20.

7) Chor S Chim et al. Primary CD56 positive lymphomas of the gastrointestinal tract. Cancer 2000; 91: 525-33.

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