Management of stage IE primary gastric lymphoma

From 1975 to 1991, stage IE gastric lymphoma was diagnosed or treated in 40 patients at our institution. Thirty-five evaluable patients were the subject of this analysis (median age, 63 years). All histologic specimens were reviewed and classified according to the working formulation. Immunohistochemical stains were performed in 33 of 35 cases. The following histologic subtypes were identified: 26 patients had diffuse large cell, 2 had diffuse mixed cell, and 7 had mucosa-associated lymphocytic lymphoma (small lymphocytic lymphoma with features of MALT lymphoma). Of the 35 patients, 30 (86%) underwent laparotomy, with subtotal or total gastrectomy performed in 29. After gastrectomy, 17 patients had radiation therapy, 3 had chemotherapy, 2 had radiation plus chemotherapy, and 7 had no further treatment. Five patients were diagnosed with endoscopic biopsy and had radiation therapy, chemotherapy, or both without further surgical treatment. The median follow-up period was 69.2 months. The commonest presenting symptom was pain. The 5-year disease-free survival was 90% for the entire group and 88% for the 28 patients with working formulation intermediate histology. For patients with MALT lymphoma, the 5-year disease-free survival was 100%. The prognosis for patients with stage IE working formulation intermediate-histology gastric lymphoma is good and for those with stage IE MALT lymphoma, excellent.