[Post-therapeutic evolution and prognostic factors of intestinal lymphomas, Retrospective analysis of 42 cases].
OBJECTIVE
To evaluate in retrospect the response to therapy and long-term evolution of a series of primitive intestinal lymphomas.


METHODS
The series was comprised of 42 patients diagnosed in our hospital during 1960-1962. The mean age was 34.5 years (range, 3-73), the M/F ratio was 21/21, and the histopathology distributes as follows: high grade (HG), 24 cases, low grade (LG), 12 cases, and mixed (LG/HG), 6 cases. B/T immunophenotype: 40/2. Staging: IE1,29 cases, IIE2-IV, 11 cases. The treatment applied in the series was classified in various types: ample surgical resection (aSR), 21 cases; partial surgical resection (pSR), 9 cases; abdominal radiation therapy (RT), 7 cases; monochemotherapy (MCT), 7 cases, and polychemotherapy (PCT), 28 cases. The correlation of clinicobiological variables with immediate response to treatment was evaluated by means of the chi square test, and the acturial post-therapeutic survival curves in accordance to the life tables, differences being calculated by the log rank test.


RESULTS
Small intestine was the commonest site of involvement, 31 cases; ileocecal region, 7 cases; colon, 2 cases, and colon plus small intestine, 2 cases. Regardless of therapy type, complete remission (CR) was attained in 20 patients (47.5%), partial remission in 5; 11 cases were unresponsive (26.5%) and early death occurred in 6 instances (14.2%). The acturial post-therapeutic survival offered an 8-year expectancy of 47%. The correlation between immediate complete response and 16 clinico-biologic variables showed favourable significance for tumoral proliferation index (i.e., Pc10-positive cells < 15%) and for therapeutic regimens including PCT+aSR. On the other hand, the necessity of emergency surgery for diagnosis was a poor-risk factor. The correlation between a post-therapeutic survival and 19 other variables showed the following as favorable data: female sex, tumour proliferative index (i.e., Pc10-positive cells < 15%), the use of PCT+aSR, and attaining CR. Poor-risk factors were the need of emergency surgery, multicentric lymphomatous involvement and serum LDH rates 350 UI/L. Although immediate response (CR) and long-term results (survival) were better in the patients with favourable histology (LG+LG/HG) and in those with loco-regional disease (stages IE-IE1), the differences had no statistical significance, possibly due to the low number of cases.


CONCLUSIONS
1) Even though these findings should be carefully evaluated, dut to lack of homogeneity of the series and the fact of being a retrospective study, the rate of CR in this series (47.5%) is similar to that of current studies. 2) Female sex, type of therapy, multifocal involvement, the need of emergency surgery and high LDH levels have significant value in univariate analyses.
Sánchez-Fayos
M P
MP
Servicio de Aparato Digestivo, Fundación Jiménez Díaz, Facultad de Medicina, Universidad Autónoma, Madrid.
Hernández Guío
C
C
Rivas
M C
MC
Outeiriño
J
J
González-Campos
C
C
Lobo
F
F
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D000477:Alkylating Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D007414:Intestinal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011878:Radiotherapy; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013514:Surgical Procedures, Operative; D016019:Survival Analysis; D016896:Treatment Outcome
D000477:Alkylating Agents
Evolución posterapéutica y factores pronósticos de los linfomas intestinales. Análisis retrospectivo de 42 casos.