Primary lymphomas of the gastrointestinal tract. Analysis of prognostic factors with emphasis on histological type.

We have analyzed the clinicopathological factors affecting survival in 60 primary gastrointestinal lymphomas seen at Memorial Hospital between 1949 and 1978. Patients with generalized lymphoma (Stages III and IV) at the time of diagnosis and those without follow-up information or adequate histological material were excluded from this study. Lymphomas were classified according to the Lukes-Collins, Kiel, and Rappaport schemes and the patients were staged retrospectively by a modified Ann Arbor system. The patients were treated by surgical resection, radiotherapy, or both. Survival was influenced by histological type (P = 0.0116), stage of the disease (P less than 0.0001), and size of the primary tumor (P = 0.0007). Low-grade lymphoplasmacytoid lymphomas, recognized in 26.6% of the cases, had a low rate of extra-abdominal recurrence; 74% of these patients were alive without evidence of recurrence after a median follow-up of 171 months, or died without evidence of lymphoma with a median survival of 147 months. Centrocytic (Kiel) or cleaved cell (Lukes-Collins) types were seen in 13% and 21%, and high grade (Kiel) or large noncleaved and immunoblastic (Lukes-Collins) in 33.3% and 30% of the cases, respectively. These groups had a high rate of extra-abdominal recurrences, and over 60% of the patients died of lymphoma, with a median survival of 8 for the centroblastic-centrocytic and 7 months for the high-grade tumors. Histological type and clinicopathological staging emerge as useful factors for the identification of patients with high risk of systemic recurrence, probably best treated with chemotherapy in addition to surgery and local radiotherapy.