Diagnosis and management of stage IE and stage IIE gastric lymphomas

We performed a retrospective study involving 56 patients with stage IE or stage IIE gastric lymphomas treated between January 1980 and January 1990. Endoscopy had a sensitivity of 98% compared with 83% for radiographic contrast studies. The data were analyzed with respect to 10 prognostic factors. Age greater than 65 years and an elevated lactate dehydrogenase level were associated with a significantly lower 5-year survival rate (each p=0.001). Those patients having had gastric resection with grossly negative margins demonstrated improved survival compared with those patients who did not have complete resection (67% versus 29%). The use or omission of radiotherapy had no effect on survivorship (51% versus 55%). Neither tumor size, stage, sex, site of extragastric involvement, time from onset of symptoms to diagnosis, nor microscopic resection margins influenced survival. We conclude that endoscopy with biopsy is the diagnostic procedure of choice for gastric lymphoma. Gastric resection still plays an important role in the management of stage IE and stage IIE gastric lymphomas, whereas chemotherapy remains the mainstay of therapy. The role of radiotherapy remains undefined.