Objective: To evaluate the outcome of surgical resection and rituximab for treatment of primary gastric diffuse large B cell lymphoma (PGDLBCL).
Methods: Data of 83 patients with primary gastric diffuse large B cell lymphoma were reviewed retrospectively. 40 patients received surgical resection followed by chemotherapy, and the other 43 patients chemotherapy alone. The two groups were further divided into four sub- groups according to chemotherapy regimens (CHOP or R- CHOP). Overall survival (OS) and progression free survival (PFS) as two prognostic indexes were analyzed.
Results: The median age of these 83 cases at diagnosis was 52 years (range, 20-76 years) with a male-to-female ratio of 43 to 40. And the follow-up duration ranged from 4-59 months (mean 36 months). The 5-year PFS for the patients received surgery and chemotherapy was 66.7%. PFS for the patients received chemotherapy alone was 82.6%. And 5-year OS for these two groups was 68.4% and 85.9%,respectively. OS and PFS of chemotherapy alone group were better than the other one without statistically significance. In the combined group, the 5- year OS were 73.6% for patients received R- CHOP and 64.2% for patients received CHOP; the 5- year- PFS were 71.2% and 62.5%, respectively. Meanwhile, the 5- year OS for patients received R-CHOP and CHOP were 85.7% and 83.5%; the 5-year-PFS were 83.4% and 81.8%, respectively. The OS and PFS did not differ significantly (P>0.05) between two chemotherapy regimens. According to the Lugano stage, those who received chemotherapy alone for the patients with advanced stage (Ⅱ2, ⅡE or Ⅳ) had better OS compared with received surgery and chemotherapy. A significant difference was found between the two groups (P<0.05). However for the patients with early stage (Ⅰ or Ⅱ 2), there was no statistically significance between the two groups (P>0.05). Univariate analysis showed that age, ECOG, Lugano stage, level of LDH and IPI score (P<0.05) were factors of survival in patients with PGDLBCL. And multivariate analysis showed that IPI score was an independent prognostic factor for OS.
Conclusion: The survival of the patients received combined surgery and chemotherapy was not superior to those received chemotherapy alone. There was no statistically significance between two different regimens for prognosis of PGDLBCL. Because of poor quality of life caused by surgery, surgery shouldn't now been recommended for the patients with PGDLBCL without operative indication. Rituximab had no positive influence on OS and PFS in most patients with PGDLBCL, but this result should be confirmed by further large sample and multi-center study.
目的: 探讨手术联合化疗与单纯化疗对原发胃弥漫大B细胞淋巴瘤（PGDLBCL）患者生存的影响，并分析化疗过程中联合应用利妥昔单抗（R）对其预后的影响。
方法: 回顾性分析83例PGDLBCL患者的临床资料，并分析外科手术及利妥昔单抗对患者生存的影响。
结果: 83例患者中男43例，女40例，中位年龄52 (20~76）岁，中位随访时间为36 (4~59）个月。手术联合化疗组（40例）和单纯化疗组（43例）患者的5年总生存（OS）率分别为68.4%、85.9%（P=0.117），疾病无进展生存（PFS）率分别为66.7%、82.6%（P=0.258），差异均无统计学意义。手术联合化疗患者中R-CHOP方案组（23例）和CHOP方案组（17例）患者的5年OS率分别为73.6%、64.2%（P=0.113），PFS率分别为71.2%、62.5%（P= 0.147）；单纯化疗患者中R-CHOP方案组（24例）和CHOP方案组（19例）患者的5年OS率分别为85.7%、83.5%（P=0.152），PFS率分别为83.4%、81.8%（P=0.307）。单纯化疗组和手术联合化疗组Lugano分期早期（Ⅰ~Ⅱ1期）患者的5年OS率分别为86.4%、78.7%，差异无统计学意义（P=0.283）；晚期（Ⅱ2~Ⅳ期）患者分别为74.6%、58.5%，差异有统计学意义（P=0.040）。多因素分析显示IPI评分是影响预后的独立因素（RR=0.370，95% CI 0.089~3.537，P=0.015）。
结论: 单纯化疗或手术联合化疗对PGDLBCL患者长期生存的影响差异无统计学意义，但由于手术可能造成患者生存质量的下降，因此对于无手术指征者更倾向于推荐单纯化疗。本研究中利妥昔单抗的联合应用未能使大部分这类患者的生存显著获益，但这需要进一步多中心、大样本的研究来证实。