Controversies and consensus in the diagnosis, work-up and treatment of gastric lymphoma: an international survey.
BACKGROUND
Variations in diagnostic criteria and staging procedures in cancer patients have important consequences for patient selection and often preclude meaningful comparison of published series. In gastric lymphoma, these effects will play a role, since diagnostic criteria are controversial. Moreover, staging procedures and therapeutic choices are influenced by insights from different clinical specialisms.


METHODS
To review the management of gastric lymphoma, formatted questionnaires were mailed to leading institutes with a special interest in this field in Europe, the United States and Japan.


RESULTS
Nineteen centers agreed to contribute. Minimum histological criteria varied among pathologists with a notable influence of the classification system used in the different countries. Detailed evaluation of the lymphoma distribution in the gastric wall and routine staging of the GI-tract differed between groups leaded by medical oncologists and gastroenterologists. This results in basically different patient selections and bias in treatment outcome. Similar effects were recorded for the role of gastric resection and radiotherapy.


CONCLUSIONS
This study gives insight in the basis of the decisions that result in different approaches in the management of gastric MALT-NHL and in the effects for patient selection and treatment results and may help in the design of future clinical trials.
de Jong
D
D
Department of Pathology, The Netherlands Cancer Institute, Amsterdam. djong@nki.nl
Aleman
B M
BM
Taal
B G
BG
Boot
H
H
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001707:Biopsy, Needle; D003625:Data Collection; D005060:Europe; D005260:Female; D005773:Gastroscopy; D017408:Guidelines as Topic; D006801:Humans; D007564:Japan; D018442:Lymphoma, B-Cell, Marginal Zone / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008297:Male; D009367:Neoplasm Staging / Q000592:standards; D011379:Prognosis; D011878:Radiotherapy / Q000379:methods; D015203:Reproducibility of Results; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
D000970:Antineoplastic Agents