Surgery is an effective clinical approach that has been used for the treatment of gastric lymphoma. However, its specific effect on the prognosis of patients with gastric lymphoma remains largely unknown. The current meta-analysis aimed to identify the effect of surgery on the prognosis of gastric lymphoma.
Methods
We searched the MEDLINE, Embase, and Cochrane Central databases to obtain relevant studies investigating the influence of surgery on overall survival (OS) and relapse-free survival (RFS). We extracted the hazard ratios (HRs) and associated 95% confidence intervals (CIs) of each included report for pooled analysis. We assessed heterogeneity (I2 statistic) and funnel plots to select the data models and evaluate publication bias.
Results
Ultimately, we included 12 studies containing 26 comparisons in the current quantitative meta-analysis. The analysis revealed that surgery had no significant effect on OS (HR .83, P = .13) or RFS (HR .78, P = .08). However, subgroup analysis revealed that the effect of surgery on OS differed significantly between the surgery plus conservative therapy subgroup and the conservative therapy alone groups, with HR = .69 (P = .01). No significant publication bias was detected regarding the main outcomes.
Conclusion
Surgery had a limited effect on the prognosis of patients with gastric lymphoma. However, the use of surgery as an additional therapy may confer potential benefits. This was an interesting research direction, and additional high-quality, large-scale randomized controlled trials should be conducted.
Al-AkwaaAMSiddiquiNAl-MoflehIA. Primary gastric lymphoma. World J Gastroenterol. 2004;10(1):5-11.
2.
WangYZhaoLLiuC, et al.Clinical characteristics and prognostic factors of primary gastric lymphoma: A retrospective study with 165 cases. Medicine (Baltim). 2016;95(31):e4250.
3.
GhimirePWuGZhuL. Primary gastrointestinal lymphoma. World J Gastroenterol. 2011;17(6):697-707.
4.
AroraNManipadamMTPulimoodA, et al.Gastrointestinal lymphomas: pattern of distribution and histological subtypes: 10 years experience in a tertiary centre in South India. Indian J Pathol Microbiol. 2011;54(4):712-719.
5.
Medina-FrancoHGermesSSMaldonadoCL. Prognostic factors in primary gastric lymphoma. Ann Surg Oncol. 2007;14(8):2239-2245.
Juárez-SalcedoLMSokolLChavezJCDaliaS. Primary Gastric Lymphoma, Epidemiology, Clinical Diagnosis, and Treatment. Cancer Control. 2018;25(1):1073274818778256.
8.
BartlettDLKarpehMSFilippaDABrennanMF. Long-term follow-up after curative surgery for early gastric lymphoma. Ann Surg. 1996;223(1):53-62.
9.
KoderaYYamamuraYNakamuraS, et al.The role of radical gastrectomy with systematic lymphadenectomy for the diagnosis and treatment of primary gastric lymphoma. Ann Surg. 1998;227(1):45-50.
10.
YoonSSCoitDGPortlockCSKarpehMS. The diminishing role of surgery in the treatment of gastric lymphoma. Ann Surg. 2004;240(1):28-37.
MerchionneFIacopinoPMinoiaC, et al.Targeted strategies in the treatment of primary gastric lymphomas: from rituximab to recent insights into potential new drugs. Curr Med Chem. 2014;21(8):1005-1016.
13.
ZulloAHassanCCristofariF, et al.Effects of Helicobacter pylori eradication on early stage gastric mucosa-associated lymphoid tissue lymphoma. Clin Gastroenterol Hepatol. 2010;8(2):105-110.
14.
Ruskoné-FourmestrauxAMatysiak-BudnikTFabianiB, et al.Exclusive moderate-dose radiotherapy in gastric marginal zone B-cell MALT lymphoma: Results of a prospective study with a long term follow-up. Radiother Oncol. 2015;117(1):178-182.
15.
VargoJAGillBSBalasubramaniGKBeriwalS. Treatment Selection and Survival Outcomes in Early-Stage Diffuse Large B-Cell Lymphoma: Do We Still Need Consolidative Radiotherapy?J Clin Oncol. 2015;33(32):3710-3717.
16.
SchwarzRJConnersJMSchmidtN. Diagnosis and management of stage IE and stage IIE gastric lymphomas. Am J Surg. 1993;165(5):561-565.
17.
DurrEDBonnerJAStricklerJG, et al.Management of stage IE primary gastric lymphoma. Acta Haematol. 1995;94(2):59-68.
18.
GobbiPGDionigiPBarbieriF, et al.The role of surgery in the multimodal treatment of primary gastric non-Hodgkin’s lymphomas. A report of 76 cases and review of the literature. Cancer. 1990;65(11):2528-2536.
19.
PageMJMcKenzieJEBossuytPM, et al.The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
20.
TierneyJFStewartLAGhersiDBurdettSSydesMR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials. 2007;8:16.
21.
AvilésADíaz-MaqueoJCTorreA, et al.Is Surgery Necessary in the Treatment of Primary Gastric Non-Hodgkin Lymphoma?Leuk Lymphoma. 1991;5(5-6):365-369.
22.
AvilésANamboMJNeriN, et al.The role of surgery in primary gastric lymphoma: results of a controlled clinical trial. Ann Surg. 2004;240(1):44-50.
23.
BinnMRuskoné-FourmestrauxALepageE, et al.Surgical resection plus chemotherapy versus chemotherapy alone: comparison of two strategies to treat diffuse large B-cell gastric lymphoma. Ann Oncol. 2003;14(12):1751-1757.
24.
BlairSShahSTamimWQuinlanRSwansonR. Surgical resection improves survival in the treatment of early gastric lymphomas. J Gastrointest Surg. 2000;4(3):304-309.
25.
BurgersJMTaalBGHeerdePSomersRJagerFCHHartAA. Treatment results of primary stage I and II non-Hodgkin’s lymphoma of the stomach. Radiother Oncol. 1988;11(4):319-326.
26.
ChangMHuangMSuYChangYLinJHsiehRK. Clinical outcome of primary gastric lymphoma treated with chemotherapy alone or surgery followed by chemotherapy. J Formos Med Assoc. 2006;105(3):194-202.
27.
LiuHTHsuCChenCL, et al.Chemotherapy alone versus surgery followed by chemotherapy for stage I/IIE large-cell lymphoma of the stomach. Am J Hematol. 2000;64(3):175-179.
28.
VigliottiMLDell’OlioMRomanoG, et al.Primary gastric lymphoma for stage I/II1 E: operative and conservative management in retrospective data from 71 cases. Leuk Lymphoma. 2003;44(7):1259-1261.
29.
MehmetKSenerCUyeturkU, et al.Treatment modalities in primary gastric lymphoma: the effect of rituximab and surgical treatment. A study by the Anatolian Society of Medical Oncology. Contemp Oncol. 2014;18(4):273-278.
30.
ValicentiRKWassermanTHKucikNA. Analysis of prognostic factors in localized gastric lymphoma: the importance of bulk of disease. Int J Radiat Oncol Biol Phys. 1993;27(3):591-598.
31.
YangHWuMShenY, et al.Treatment Strategies and Prognostic Factors of Primary Gastric Diffuse Large B Cell Lymphoma: A Retrospective Multicenter Study of 272 Cases from the China Lymphoma Patient Registry. Int J Med Sci. 2019;16(7):1023-1031.
32.
SbittiYIsmailiNBensoudaYKadiriHIchouMErrihaniH. Management of stage one and two-E gastric large B-cell lymphoma: chemotherapy alone or surgery followed by chemotherapy?J Hematol Oncol. 2010;3:23.
33.
SeifertESchulteFStolteM. Long-term results of treatment of malignant non-Hodgkin’s lymphoma of the stomach. Z Gastroenterol. 1992;30(8):505-508.
34.
PasiniFAmbrosettiASabbioniR, et al.Postoperative chemotherapy increases the disease-free survival rate in primary gastric lymphomas stage IE and IIE. Eur J Cancer. 1994;30A(1):33-36.
35.
DesiderioJTrastulliSD’AndreaVParisiA. Enhanced recovery after surgery for gastric cancer (ERAS-GC): optimizing patient outcome. Transl Gastroenterol Hepatol. 2020;5:11.
36.
RosaFLongoFPozzoC, et al.Enhanced recovery after surgery (ERAS) versus standard recovery for gastric cancer patients: The evidences and the issues. Surg Oncol. 2022;41:101727.
37.
BrinckerHD’AmoreF. A retrospective analysis of treatment outcome in 106 cases of localized gastric non-Hodgkin lymphomas. Danish Lymphoma Study Group, LYFO. Leuk Lymphoma. 1995;18(3-4):281-288.
38.
SchechterNRPortlockCSYahalomJ. Treatment of mucosa-associated lymphoid tissue lymphoma of the stomach with radiation alone. J Clin Oncol. 1998;16(5):1916-1921.
39.
FischbachWDragosicsBKolve-GoebelerME, et al.Primary gastric B-cell lymphoma: results of a prospective multicenter study. The German-Austrian Gastrointestinal Lymphoma Study Group. Gastroenterology. 2000;119(5):1191-1202.
40.
TsangRWGospodarowiczMKPintilieM, et al.Localized mucosa-associated lymphoid tissue lymphoma treated with radiation therapy has excellent clinical outcome. J Clin Oncol. 2003;21(22):4157-4164.
41.
HammelPHaiounCChaumetteMT, et al.Efficacy of single-agent chemotherapy in low-grade B-cell mucosa-associated lymphoid tissue lymphoma with prominent gastric expression. J Clin Oncol. 1995;13(10):2524-2529.
42.
PfreundschuhMTrümperLOsterborgA, et al.CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol. 2006;7(5):379-391.
43.
HuCDengCZouWZhangGWangJ. The Role of Consolidative Radiotherapy after a Complete Response to Chemotherapy in the Treatment of Diffuse Large B-Cell Lymphoma in the Rituximab Era: Results from a Systematic Review with a Meta-Analysis. Acta Haematol. 2015;134(2):111-118.
44.
Ruskoné-FourmestrauxAFischbachWAlemanBMP, et al.EGILS consensus report. Gastric extranodal marginal zone B-cell lymphoma of MALT. Gut. 2011;60(6):747-758.
45.
FischbachWMalfertheinerPHoffmannJC, et al.S3-guideline “helicobacter pylori and gastroduodenal ulcer disease” of the German society for digestive and metabolic diseases (DGVS) in cooperation with the German society for hygiene and microbiology, society for pediatric gastroenterology and nutrition e. V., German society for rheumatology, AWMF-registration-no. 021/001. Z Gastroenterol. 2009;47(12):1230-1263.
46.
WillichNAReinartzGHorstEJ, et al.Operative and conservative management of primary gastric lymphoma: interim results of a German multicenter study. Int J Radiat Oncol Biol Phys. 2000;46(4):895-901.
47.
CirocchiRFarinellaETrastulliS, et al.Surgical treatment of primitive gastro-intestinal lymphomas: a systematic review. World J Surg Oncol. 2011;9:145.
48.
ShuYXuXYangWXuL. Surgery plus chemotherapy versus chemotherapy alone in primary intestinal lymphoma: a meta-analysis. J Int Med Res. 2021;49(11):3000605211056845.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
