title: Primary gastric non-Hodgkin's lymphoma: clinical features, management, and prognosis of 185 patients with diffuse large B-cell lymphoma.
abstract: BACKGROUND
  Primary gastric non-Hodgkin's lymphoma (PG-NHL) is common in Saudi Arabia. This has prompted the analysis of a large series of patients with PG-NHL having high-grade diffuse large B-cell lymphoma (DLCL) in order to define the clinical features and outcome of this disease.
  
  
  METHODS
  The data of all adult patients in the series with PG-NHL having DLCL histology were retrospectively reviewed. Patients were eligible if they had biopsy-confirmed diagnoses obtained by endoscopy or following laparotomy.
  
  
  RESULTS
  Over a 16-year period, 185 patients with DLCL PG-NHL were identified and their data were reviewed. Patients had a median age of 54 years. In 53% of them only one initial therapeutic modality was given, while 47% were managed by a multi-modality approach. One hundred forty patients (76%), 19 (10%), and 26 (14%) attained complete remission (CR), partial remission, and no response/progressive disease, respectively. Multivariate analysis showed that poor performance status and advanced stage were negatively associated with the likelihood of attaining CR. Over a median follow-up of 54 months, 118 (64%) of the patients were alive and disease-free, 17 (9%) were alive with evidence of disease, and the remaining 50 (27%) were dead. The projected 5-year and 10-year overall survivals (OS) (+/- SD) were 68% (+/- 4%) and 61% (+/- 6%), respectively. The Cox proportional hazards model identified the same variables of response as adverse prognostic factors of survival. Using the influence of performance status, and stage, a prognostic index was constructed to recognize three prognostically distinctive risk categories with overall survival proportions of 87%, 61%, and 45%, respectively. The unadjusted International Prognostic Index, however, failed to classify patients into prognostically meaningful risk strata. Of the 140 patients who achieved CR, the median disease-free survival (DFS) was not reached, but the predicted 5- and 10-year DFS were 82% and 75%, respectively. A multivariate analysis identified poor performance status as the only independent prognostic covariate that adversely influenced DFS. Our analysis showed that compared with single-modality management, multi-modality strategy attained significantly higher CR, and advantageous OS and DFS.
  
  
  CONCLUSIONS
  This large series characterized the clinico-pathologic features and outcome of patients with DLCL PG-NHL. Performance status, and stage significantly influenced patient outcome. A prognostic index was developed and it identified three prognostically distinctive risk groups; however, prospective validation is warranted.
authors.affiliation: Department of Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. ezzibrahim@kfshrc.edu.sa
authors.forename: E M
authors.initials: EM
authors.lastname: Ibrahim
authors.forename: A A
authors.initials: AA
authors.lastname: Ezzat
authors.forename: M A
authors.initials: MA
authors.lastname: Raja
authors.forename: M M
authors.initials: MM
authors.lastname: Rahal
authors.forename: D S
authors.initials: DS
authors.lastname: Ajarim
authors.forename: B
authors.initials: B
authors.lastname: Mann
authors.forename: A
authors.initials: A
authors.lastname: Baloush
authors.forename: R K
authors.initials: RK
authors.lastname: Stuart
authors.forename: S N
authors.initials: SN
authors.lastname: Bazarbashi
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D016015:Logistic Models; D016393:Lymphoma, B-Cell / Q000097:blood / Q000401:mortality / Q000628:therapy*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009363:Neoplasm Proteins / Q000097:blood; D016017:Odds Ratio; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000097:blood / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis
chemical_list: D009363:Neoplasm Proteins; D007770:L-Lactate Dehydrogenase