Gastrointestinal lymphomas: the Würzburg study experience

Appropriate management of primary gastric lymphomas is still controversial. We, therefore, conducted a prospective multicenter study to identify its clinical features, evaluate the accuracy of diagnostic and staging procedures, and assess a treatment strategy based on tumor stage and malignancy. Of 266 patients recruited within three years, 107 had low-grade (40%) and 159 high-grade (60%) lymphoma. A total of 237 patients (89%) presented with localized disease (stages EI/II). Based on the rapid urease test and/or histology the overall Helicobacter pylori positivity was 59% (76%, 51%, 38% in low-grade, high-grade, and secondary high-grade lymphoma, respectively). In 27% of the cases, patients could not be precisely classified and graded on the basis of endoscopic biopsies. In 78 patients, pre-operative endoscopic ultrasound correctly predicted the depth of tumor infiltration in 78% and lymph-node involvement in 75%. Treatment was stratified according to the grade of malignancy and stage: H. pylori eradication in low-grade lymphoma of stage EI, surgical resection in stages EI/II of low- and high-grade lymphoma and, depending on the pathohistological stage and post-operative residual tumor mass radiation and chemotherapy/combined radiochemotherapy in low-grade and high-grade lymphoma, respectively.