[Non-Hodgkin's malignant lymphoma with primary gastro-intestinal localisation. Therapeutic aspects]

A retrospective analysis of 38 patients with primary gastrointestinal non Hodgkin's lymphoma (PGINHL) referred to "Center Oscar Lambret, Lille, France", from January 1964 to December 1986 has been carried out. Kiel classification and the working formulation for clinical usage were used for histologic diagnosis and Ann Arbor classification modified by Musshoff for clinical staging. The patients, 29 males and 9 females, ranged in age from 7 to 71 years with a mean of 45.5 years for men and 45.1 years for women. Seventeen patients were classified as presenting with low-grade malignancy lymphomas and 21 as high-grade malignancy lymphomas. Nineteen patients presented with early clinical forms and 19 with advanced ones. Laparotomy was performed on all patients but one. Treatment modalities included: surgical resection, chemotherapy and radiotherapy in various combinations. There were 21 patients with recurrence, 6 of them responding to retreatment. The complete population survival curve reached a plateau at 48% after a 41-month follow-up. Five-year survival was 16% for early clinical forms and 80% for advanced ones (P less than 0.001) and 24% for high-grade malignancy lymphomas versus 75% for low-grade malignancy lymphomas (P less than 0.01). Moreover, the 5-year survival rate was 82% for patients with complete surgical resection of primary lesions versus 16% for those with incomplete resections (P less than 0.001). Laparotomy seems to play a major role in diagnostic accuracy, although the role of surgery in therapeutic management remains controversial. However our findings show that surgical resection is important to achieve local control of PGINHL. According to our results the only prognostic determinant that keeps its prognostic value is the extent of surgical resection (complete or incomplete) (P less than 0.05).