Clinicopathological study of primary gastric lymphomas in the central region of Tunisia, with survival analysis.

BACKGROUND: Primary gastric lymphomas (PGL) are rare and represent only 5% of gastric malignancies, but are apparently increasing in incidence worldwide. Optimal treatment of PGL remains controversial. The aim of this study was to evaluate clinicopathological characteristics, prognostic factors, survival rates, and treatment modalities in Tunisian patients with PGL. METHODS: We retrospectively analyzed data from patients treated for PGL in our hospital over an 18-year period (1994-2011). RESULTS: Data from 128 patients with PGL were retrospectively analyzed. Eighty-four were males and the median age was 57 years (range 5-89 years). The mean BMI was 22.9 (15-39). A total of 40 patients (31.2%) had a poor performance status (PS). The antrum was the most commonly involved site (52 cases, 40.6%). The most frequent pathological subtypes were diffuse large-cell lymphomas (46.4%) and mucosa-associated lymphoid tissues (32%). Disease was localized (stages IE and IIE) in 97 patients (75.8%). Ninety-six patients were evaluable. Chemotherapy alone was used in 73 (76%) patients, with 76.7% achieving complete remission. During chemotherapy, there were no severe complications requiring urgent surgery. Actuarial five-year overall and event-free survival were 60.2 and 54.3% respectively. We found no statistically significant difference in survival between patients treated with surgery and those treated by a conservative strategy. In the multivariate study, age greater than 60 years, poor PS, and BMI less than 20 were significant prognostic factors for overall survival (P=0.04, 0.009, and <0.001, respectively). CONCLUSION: Surgery provides no advantage for survival over conservative treatment. Age, PS, and BMI were effective prognostic factors.

[Primary small intestinal lymphoma: epidemiological, histological and therapeutic transition in Tunisia]. / Transition épidémiologique, histologique et thérapeutique des lymphomes primitifs du grêle (LPG) en Tunisie.

INTRODUCTION: Primary small intestinal lymphoma (PSIL) is the second Non-Hodgkin lymphoma (NHL) of the digestive tract (after gastric NHL). PURPOSE: To evaluate during the past 28 years the epidemiological, anatomoclinical and therapeutic changes of PSIL in Tunisia through an acquired experience of more than a quarter of a century. METHODS: Our retrospective study included patients with histologically confirmed small intestinal lymphoma from 1981 to 2008 in Tunisia at Salah Azaiz Institute. The cohort of 210 patients was divided into two groups: A group from 1981 to 1992 (152 patients) and B group from 1993 to 2008 (58 patients). We analysed the epidemiological, anatomoclinical, histological, and therapeutic characteristics. RESULTS: We observed a significant decrease in the annual incidence of PSIL but also a significant transition of diffuse immunoproliferative small intestinal disease (IPSID) also known as "Mediterranean" PSIL, which were progressively replaced by "Western" lymphomas. Laparotomy with or without a debulking surgery, largely performed in group A, has disappeared at the cost of a primary chemotherapy (p < 0.001). Five-year actuarial global and relapse free survivals were respectively 60.5 and 57.3%. CONCLUSION: PSIL in Tunisia were subjected to a triple transition: epidemiological, histological and therapeutic.