2001 Gastric PCE: Overview of the Treatment of Gastric Lymphoma in the United States
Ijeoma A. Azodo1, Kaye M. Reid1, Lina Patel2, John H. Donohue1,2, Members of the Gastric PCE Project The2; 1General Surgery, Mayo Clinic - Rochester, Rochester, MN; 2American College of Surgeons, Commission on Cancer, Chicago, IL
BACKGROUND: The management of gastric lymphoma has changed from surgical to medical over the last several decades. Our aim was to evaluate the current management of gastric lymphoma in the United States ( U.S. ).METHODS: Data from 711 U.S. hospitals in the Gastric Cancer Patient Care Evaluation (PCE) Study sponsored by the National Cancer Data Base (NCDB) were reviewed. Participating institutions submitted patient data from hospital admissions and/or clinic visits for the period of January 1, 2001 to December 31, 2001. RESULTS:Lymphomas accounted for 10% (688/7084) of the gastric malignancies submitted in this study. The lymphoma population was predominatingly white (74%) and men outnumbered women (57% to 42 %). The mean age at diagnosis was 68.5 with the peak age prevalence in the seventh decade (31%). The frequencies of presenting symptoms are tabulated in Table 1. A history of Helicobacter pylori infection was present in 24% of patients, 29% had negative testing. The most common gastric lymphoma sites were unspecified/diffuse (38%) and cardia (15%). Large cell diffuse lymphoma, NOS was present in 47% of patients and marginal zone B cell lymphoma in 36%. The majority of patients (87%) were treated without an operation. In the 88 patients that had an operation, 23% underwent a distal gastrectomy. Radiation therapy was used in 21% and chemotherapy was administered in 51% of patients. Single drug chemotherapy was the most common regimen. The 30-day surgical mortality was 13% and an additional 6% of deaths in the hospital >30 days postoperatively. The total surgical mortality was 19%. Long term follow-up data are unavailable at this time. CONCLUSIONS: Gastric lymphoma is a rare disease occurring more often in older Caucasian men. Operative therapy is currently used infrequently (10%), a finding that agrees with recent studies of this malignancy. Significant mortality is associated with surgical intervention for gastric lymphoma.
Table 1: Pre-diagnostic symptoms of Gastric Lymphoma
| Symptom | (%) |
| Pain | 74 |
| Weight loss | 61 |
| Melena | 47 |
| Early satiety | 40 |
Table 2: Postoperative Morbidity and Mortality
| Complication | (%) |
| 30-day mortality* | 13 |
| Hospital Death >30 days | 6 |
| Wound Infection | 5 |
| Sepsis | 4 |
| Hemorrhage | 3 |
| Doudenal Stump leak | 3 |
*In hospital (6%) & Post-discharge (7%)
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