Med Oncol (2012) 29:227–234
DOI 10.1007/s12032-010-9783-x
ORIGINAL PAPER
Clinical prognostic analysis of 116 patients with primary intestinal
non-Hodgkin lymphoma
Hong-Feng Gou • Jian Zang • Ming Jiang •
Yu Yang • Dan Cao • Xin-Chuan Chen
Received: 6 September 2010 / Accepted: 10 December 2010 / Published online: 31 December 2010
Ó Springer Science+Business Media, LLC 2010
Abstract The gastrointestinal tract is the most common
extranodal invasion site of non-Hodgkin lymphoma
(NHL). Primary gastrointestinal NHL is often discussed
together in most survival analyses. Primary intestinal NHL
is significantly different from primary gastric NHL with
regard to clinical features, pathological subtype, treatment,
and prognosis. In this article, we analyzed clinical and
pathological characteristics of primary intestinal NHL, and
we also explored prognostic factors for primary intestinal
NHL. A retrospective analysis was carried out on clinical
data from 116 cases of confirmed primary intestinal NHL.
The Kaplan–Meier method was used for the survival
analysis. A Cox model was used for a multivariate analysis.
In 116 patients with primary intestinal NHL, 79 patients
were men (68.1%) and 37 patients were women (31.9%). In
the cases used in this study, 68 were B-cell NHL and 48
were T-cell NHL. The age, incidence of intestinal
obstruction, B symptom and performance status (PS) were
closely related with pathological subtype. One-year and
two-year survival rates were 76.7 and 58.3%, respectively.
The log-rank univariate analysis showed male patients, PS
score greater than or equal to two, hypoproteinemia,
intestinal perforation, T-cell type, late stage (III/IV), no
radical surgery, and no chemotherapy had relatively poor
prognoses. Cox multivariate analysis shown that gender
H.-F. Gou
J. Zang
M. Jiang
Y. Yang
D. Cao
Center of Medical Oncology, West China Hospital,
Sichuan University, Chengdu, China
e-mail: Joan.gou@gmail.com
X.-C. Chen (&)
Department of Hematology, West China Hospital,
Sichuan University, No. 37 Guo Xue Xiang St, 610041 Chengdu,
Sichuan Province, China
e-mail: heartboat@gmail.com
(95.0% CI 0.218–0.721), pathological subtype (95.0% CI
1.484–4.179), and radical surgery (95.0% CI 0.110–0.394)
were independent prognostic risk factor for primary intes-
tinal NHL. Male patients, T-cell intestinal lymphoma, and
no radical surgery had rapid clinical processes and poor
prognoses.
Keywords Intestinal tumor
Non-Hodgkin lymphoma

Prognosis
Introduction
Non-Hodgkin lymphoma (NHL) is a solid tumor composed
of lymphocytes. It is a group of diseases with different
morphology, immunophenotype, genetics, and clinical
features. The incidence of extranodal lymphomas in NHL
has a considerable rate as high as 30–50%. Gastrointestinal
NHL is the most common extranodal NHL, accounting for
30–45% in all extranodal NHLs [1, 2].
There are several current definitions for gastrointestinal
NHL, and most scholars use the definition given by
Isaacson (1994) [3], which states that gastrointestinal NHL
includes all patients who have an obviously predominant
tumor mass in the intestine with secondary involvement or
spread to extraintestinal sites. Clinical features, patholog-
ical features, and treatment of gastrointestinal NHL are
different from other extranodal lymphomas. Primary gas-
tric and intestinal NHLs are often discussed together in
most survival analyses, and intestinal NHL is analyzed as a
subgroup. Moreover, primary intestinal NHL is signifi-
cantly different from primary gastric NHL with regard to
clinical features, pathological subtype, treatment and
prognosis [2, 4]. In recent years, some progress has been
made in the diagnosis and treatment of primary gastric
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NHL [5–7]. However, most studies on primary intestinal
NHL were retrospective univariate analyses with small
samples due to the low incidence of intestinal NHL in
gastrointestinal NHL (19–43%) [1, 6, 8]. This current study
is also a retrospective study, but the case number was large,
and multiple factors for prognosis were analyzed. The 116
patients were all diagnosed with intestinal NHL and were
admitted to our hospital from January 1999 to December
2008. In this study, we analyzed and discussed the clinical
features, pathology, treatment and prognostic factors of
intestinal NHL.
Materials and methods
Case studies and data collection
In this study, 116 confirmed primary intestinal NHL cases
from January 1999 to December 2008 in the West China
Hospital of Sichuan University were included. The patho-
logical specimens were endoscopic biopsied and resected
specimens from surgery. All included cases met Isaacson’s
definition of primary gastrointestinal NHL. Mesenteric
NHL with invasion of the intestine was excluded. All the
clinical data were collected including age, sex, symptoms,
signs, lesions sites, B symptoms, performance status (PS)
score, lactate dehydrogenase (LDH) level, albumin levels,
hemoglobin, pathological subtype, the depth invasion,
staging and treatment. Radical surgery defined as com-
pletely primary mass resection and regional lymph nodes
dissection, while the palliative surgery included local mass
resection (R1–R2), enterostomy, and simple perforation
repair.
Staging classification, pathological classification,
and clinical evaluation
Clinical staging was done according to Musshoff’s [9]
staging standard of gastrointestinal NHL. The PS scoring
was done according to the ECOG. The pathologic classi-
fication referred to the classification of lymphoid tissue
tumor from the 2008 WHO [10].
Collection of follow-up data
The start and end point of the collection of follow-up data,
reasons for ending follow-up data collection and living
conditions of every case were clearly recorded. The follow-
up was done by telephone calls, letters or in person at the
clinic. Survival was considered as duration from diagnosis
to deaths, loss or endpoint of follow-up. The follow-up
ended in December 2009. The untreated patients were
included in the statistical analysis.
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Med Oncol (2012) 29:227–234
Statistical analysis
The SPSS13.0 statistical software was used. The relation-
ship between clinical characteristics and pathological
classification of lymphomas was analyzed by Chi-square
test. Kaplan–Meier was used for the survival analyses, and
survival curves were plotted. For the single-factor analysis,
the survival time of 116 patients were grouped, and sur-
vival curves were drawn according to the following factors:
gender, age group (\60 years and C60 years), lesion, sin-
gle lesion, multiple lesions, hemoglobin level, albumin
level, PS score, LDH, B symptoms, intestinal perforation,
obstruction, clinical stage, radical resection, pathological
subtype, and chemotherapy. A log-rank test was used for
comparison of significance between different survival
curves. Multivariate analysis was performed by the Cox-
regression model for those factors which were confirmed
significance in univariate analysis. In the above analysis,
P \ 0.05 was set as statistical significance.
Results
In the 116 cases of patients with primary intestinal NHL,
79 cases were men (68.1%) and 37 cases were women
(31.9%). The patients had ages between 12 years and
84 years with a mean age of 43.1 years. There were 14
cases with patients who were less than 18 years old. The
following lesion sites were included: 37 cases in small
intestine (31.9%), 17 cases in ileocecal (14.7%), 37 cases
in colon (31.9%), 5 cases in rectum (4.3%) and 20 cases in
multiple sites (17.2%).
Clinical manifestations included 84 cases of abdominal
pain (72.4%), 43 cases of melena or hematochezia (37.1%),
29 cases of diarrhea (25%), 19 cases of intestinal
obstruction (16.4%), 16 cases of abdominal mass (13.8%),
17 cases of intestinal perforation with acute peritonitis
(14.7%) and 60 cases of B symptoms (51.7%). Further-
more, the depth invasion in the cases was as follows:
submucosal invasion in 4 cases (3.1%), muscle layer
invasion in 15 cases (12.9%), subserosal invasion in 33
cases (28.4%), penetrates the subserosa in 31 cases (26.7%)
and unknown invasion in 33 cases (28.4%). The laboratory
tests were as follows: increased LDH in 37 cases (31.9%),
lower than normal hemoglobin in 36 cases (31%), and
hypoalbuminemia in 54 cases (46.6%). There were 70
cases (60.3%) with a PS score of zero or one, and there
were 46 cases (39.1%) with a PS score above two.
Musshoff clinical staging showed 34 cases of IE
(29.2%), 69 of IIE (59.5%), and 13 cases of III and IV.
Bone marrow involvement was only found in two cases.
Pathological analysis showed that a total of 68 cases
were derived from B-cell NHL (58.6%), including 9 cases
Med Oncol (2012) 29:227–234
of extranodal marginal zone lymphoma of mucosa-associ-
ated lymphoid tissue (MALT lymphoma), 46 cases of
diffuse large B-cell lymphoma, not otherwise specified
(DLBCL-NOS), 7 cases of Burkitt lymphoma and 6 cases
of mantle cell lymphoma. There were 48 patients (41.4%)
with T-cell derived NHL including peripheral T-cell lym-
phoma not otherwise specified in 29 cases, extranodal NK/
T-cell lymphoma, nasal type in 15 cases and anaplastic
large cell lymphoma (ALCL), ALK-positive in 3 cases,
ALK-negative in 1 case. The pathological subtypes were
closely related with age, incidence of intestinal obstruction,
B symptoms, and PS scores. All the differences were sta-
tistically significant. Patients with intestinal T-cell NHL
were younger than patients with B-cell intestinal NHL. In
this study, 87.5% of patients with intestinal T-cell NHL
were younger than 60 years old, and 72.1% of patients with
intestinal B-cell NHL were younger than 60 years old
(P = 0.046). The incidence of intestinal obstruction in the
B-cell group and T-cell group was 22.1% (15/68) and 8.3%
(4/48) (P = 0.049), respectively. The incidence of B
symptoms was 62.5% in the T-cell group and 44.1% in the
B-cell group (P = 0.05). Furthermore, 73.5% (50/68) of
patients had a PS score of zero or one in the B-cell group,
and 41.7% (20/49) of patients had a PS score of zero or one
in the T-cell group (P \ 0.05). No significant difference of
gender, stage, hemoglobin level, albumin levels, LDH,
lesion sites, or depth invasion was found between the dif-
ferent pathological groups (P [ 0.05). In the 17 cases of
intestinal perforation, 9 cases were B-cell NHL with a
perforation rate of 13.2%, and 8 cases were T-cell NHL
with a perforation rate of 16.7%, and the difference was not
statistically significant (Table 1).
A total of 100 patients had surgical treatment with the
following treatments: 72 patients underwent radical sur-
gery, and 28 patients had palliative resection or received
only a laparotomy. The remaining patients [16] did not
receive surgery. In the B-cell group, 69.1% (47/68) of
patients underwent radical surgery, and 52.1% (25/48) of
patients underwent radical surgery in the T-cell group
(P = 0.048) (Table 1). Within 3 months after surgery, 13
patients died, including 11 patients with T-cell intestinal
NHL and 2 patients with B-cell intestinal NHL. The inci-
dence of perioperative death in the B-cell group and T-cell
group was 3.0% (2/66) and 29.7% (11/37) (P = 0.002).
A total of 66 patients received postoperative chemotherapy,
and 34 patients did not receive postoperative treatment.
Out of the total number of patients, 20 refused chemo-
therapy and 14 were unable to tolerate chemotherapy
because of their poor general condition. The diagnoses and
pathological subtypes of 16 non-surgery patients were
confirmed by endoscopy and biopsy of which 11 patients
received chemotherapy and 5 patients received no treat-
ment who were included in the survival analysis. CHOP or
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a similar regimen was the main chemotherapy program for
both B-cell and T-cell intestinal NHL. In the B-cell group,
72.1% (49/68) of patients received chemotherapy, and
58.3% (28/48) of patients underwent radical surgery in the
T-cell group (P = 0.09) (Table 1).
For the survival results, 98 cases had follow-up results,
and the follow-up results for 18 cases were lost. When the
follow-up was finished, 68 patients died and 30 patients
survived with a survival time of 0.5–120 months. As for 68
dead patients, only 43 patients were confirmed the reason
of death. Among which 13 patients died within 3 months
after surgery; 23 patients died from progressive disease; 2
patients died from infection during the leucopenia period
caused by chemotherapy; 1 patient died from perforation
caused by chemotherapy, and 4 patients died from non-
tumor factors. The one-year and two-year survival rates
were 76.7, 58.6%, respectively. For the single-factor
analysis, the results showed significant difference of rela-
tion between prognosis and the following factors: gender
(Fig. 1), pathological subtype (Fig. 2), radical surgery
(Fig. 3), PS score, albumin levels, intestinal perforation,
stage, and chemotherapy. Patients with intestinal perfora-
tion had poor prognoses when compared to patients without
intestinal perforation (P = 0.002), and patients with T-cell
intestinal NHL had poor prognoses when compared to
patients with B-cell intestinal NHL (P = 0.000). Patients
in early stages (IE/IIE) had a better prognosis when com-
pared to patients in late stages (III/IV) (P = 0.015). In
addition, female patients, PS score of zero or one, normal
albumin, radical surgery and chemotherapy had better
prognoses than male patients, PS scores above two,
hypoalbuminemia, no radical surgery and no chemother-
apy. The relation was not statistically significant
(P [ 0.05) between prognosis and the following factors:
stage group, lesion site, single lesion, multiple lesions,
hemoglobin level, LDH, B symptoms and intestinal
obstruction (Table 2). The Cox proportional hazard model
was used for multivariate analysis of statistically signifi-
cant risk factors in single-factor analyses. The results
demonstrated that gender, pathological subtype, and radical
surgery were independent prognostic factors (Table 3).
Discussion
Gastrointestinal NHL accounts for 5–10% of gastrointes-
tinal cancer of which primary gastric tumor is common.
Primary intestinal NHL is rarely seen clinically and
accounts for only 19–43% of gastrointestinal tract NHLs
[1, 6, 8]. Primary intestinal NHL is common in men. In this
study, 69.2% patients were men, and the ratio of male and
female patients was 2.1–1. The average age of onset was
45 years to 70 years in previous reports of primary
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Table 1 Characteristic Characteristic No. Immunohistological phenotype P

features of patients with primary
2
GI NHL and correlation B-cell (n = 68) T-cell (n = 48) v
between immunohistological
phenotype and characteristic Age
features C60 25 49 42 3.968 0.046
\60 91 19 6
Gender
Males 79 47 32 0.078 0.780
Females 37 21 16
Location
One lesion 96 56 40 0.019 0.089
Multiple lesions 20 12 8
Hemoglobin
Abnormal 36 18 18 1.599 0.206
Normal 80 50 30
Intestinal obstruction
Yes 19 15 4 3.870 0.049
No 97 53 44
Perforation
Yes 17 8 9 1.098 0.295
No 99 60 39
LDH
Abnormal 37 20 17 0.467 0.494
Normal 79 48 31
Albumin
Abnormal 54 27 27 3.095 0.079
Normal 62 41 21
B symptoms
Yes 60 30 30 3.808 0.051
No 56 38 18
PS score
0–1 70 50 20 11.938 0.001
C2 46 18 28
Lesion sites
Small intestine 37 26 11 5.829 0.212
Ileocecal 17 9 8
Colon 37 17 20
Rectum 5 4 1
Multiple sites 20 12 8
Depth invasion
Submucosal invasion 4 3 1 2.226 0.694
Muscle layer invasion 15 8 7
Subserosal invasion 33 17 16
Penetrate the subserosa 3 18 13
Unknown invasion 33 22 11
Stage
IE/IIE 103 62 41 0.938 0.333
III/IV 13 6 7
Surgery
Radical surgery 72 47 25 3.468 0.048
Non-radical surgery 44 21 23
Chemotherapy
Yes 77 49 28 2.375 0.09
No 39 19 20

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Table 2 Univariate analysis of factors predicting overall survival

(116 patients)
Characteristic No. Percentage alive (%) P value
(five-year)

Age
C60 25 24.0(6/25) 0.095
\60 91 18.7(17/91)
Gender
Males 79 15.2(12/79) 0.03
Females 37 29.7(11/37)
Location
One lesion 96 20.8(20/96) 0.800
Multiple lesions 20 15.0(3/20)
Fig. 1 Kaplan–Meier survival curves of the 116 patients according to Hemoglobin
gender (male and female). The male patients had poor cumulative Abnormal 36 11.1(4/36) 0.096
survival in comparison with the female patients (P = 0.03)
Normal 80 23.8(19/80)
Intestinal obstruction
Yes 19 21.1(4/19) 0.112
No 97 19.6(19/97)
Perforation
Yes 17 11.8(2/17) 0.002
No 99 21.2(21/99)
LDH
Abnormal 37 13.5(5/37) 0.062
Normal 79 22.8(18/79)
Albumin
Abnormal 54 18.5(10/54) 0.012
Normal 62 21.0(13/62)
B symptoms
Yes 60 15.0(9/60) 0.197
Fig. 2 Kaplan–Meier survival curves of patients with intestinal No 56 25.0(14/56)
B-cell lymphoma (IBCL) and intestinal T-cell lymphoma (ITCL). PS score
Patients with ITCL had poor cumulative survival in comparison with 0–1 70 25.7(18/70) 0.000
patients with IBTL (P \ 0.001)
C2 46 10.9(5/46)
Lesion sites
Small intestine 37 10.8(4/37) 0.240
Ileocecal 17 11.8(2/17)
Colon 37 32.4(12/37)
Rectum 5 40.0(2/5)
Multiple sites 20 14.3(3/21)
Stage
IE/IIE 103 21.4(22/103) 0.017
III/IV 13 7.7(1/13)
Pathological subtype
T-cell 48 12.5(6/48) 0.000
B-cell 68 25.0(17/68)
Surgery
Radical surgery 72 30.6(22/72) 0.000
Non-radical surgery 44 2.3(1/44)
Fig. 3 Kaplan–Meier survival curves of the 116 patients according to
radical surgery and non-radical surgery. The patients who have Chemotherapy
undergone non-radical surgery had poor cumulative survival in Yes 77 24.7(19/77) 0.005
comparison with the patients who have undergone radical surgery No 39 10.3(4/39)
(P \ 0.001)

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Table 3 Results of a multivariate analysis in primary intestinal
lymphoma
Variables P value Odds ratio 95.0% CI
Gender
Males
Female 0.002 0.397 0.218–0.721
Surgery
Non-radical
Radical 0.000 0.208 0.110–0.394
Phenotype
B-cell
T-cell 0.001 2.491 1.484–4.179
intestinal NHL. In this study, the average age of patients
was 43.2 years and 14 patients were less than 18 years old,
which was consistent with the reports by Radaszkiewicz,
Ibrahim [4, 11]. Primary intestinal NHL may occur in any
part of intestine. Previous reports have demonstrated that
the small intestine is the most common site and that NHL
in the colon is rare [6, 12]. The incidence of NHL in the
ileocecal was 6.9–37.1% [7, 13, 14]. In this study, small
bowel lesion was still the most common site followed by
the colon, multiple sites, ileocecal, and rectum. The inci-
dence of colon NHL was 31.7%, which was higher than
other reports. Most of the primary intestinal NHLs pre-
sented as non-specific clinical manifestations, such as
abdominal pain and diarrhea, and some patients had B
symptoms. Our study was consistent with other reports in
that the abdominal pain rate was 72.5% and B symptom
rate was 52.5%. Some patients were admitted for intestinal
perforation (14.2%) and intestinal obstruction (17.5%).
Most patients with primary intestinal NHL were at an early
stage [6, 15]. In this study, 89.2% of patients were at IE and
IIE stage, and only 10.8% of patients were at III and IV
stage, which was similar to previous reports.
Approximately 60–80% of the primary intestinal NHLs
were B-cell derived [1, 2, 4, 6, 16]. In this study, B-cell NHL
accounted for 59.2%, of which 66.2% was diffuse large
B-cell lymphoma, not otherwise specified (DLBCL-NOS),
15.5% was MALT lymphoma and 8.5% was mantle cell
lymphoma, which was consistent with previous studies [2, 6,
17]. T-cell NHL is rare in primary gastric NHL and rela-
tively common in primary intestinal T-cell NHL. In Koch’s
report on 277 cases of primary gastric NHL, no T-cell NHL
was found. In 32 cases of primary intestinal NHL in Koch’s
study; however, 27% was T-cell type [7]. In this study,
T-cell intestinal NHL accounted for 40.8%. In the 49 cases
of T-cell intestinal NHL, the following classifications were
found according to the criteria of 2008 WHO: 59.2% was
peripheral T-cell lymphoma not otherwise specified, 32.7%
was extranodal NK/T-cell lymphoma, nasal type and 6.1%
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Med Oncol (2012) 29:227–234
was anaplastic large cell lymphoma (ALCL), ALK positive,
2.0% was anaplastic large cell lymphoma (ALCL), ALK
negative. A revised European-American lymphoma classi-
fication divides intestinal T-cell lymphoma into enteropa-
thy-associated and non-enteropathy-associated T-cell
intestinal NHL according to the occurrence of colitis [18].
Enteropathy-associated T-cell lymphoma (EATL) is often
secondary to chronic celiac disease caused by gluten intol-
erance and has a unique morphology, specific immune
characteristics and specific molecular characteristics [3, 19,
20]. The annual incidence rate of EATL is 0.14/100,000 in
Europe and the United States, which accounts for 1.4% of all
the NHL cases. Kohno [21] reported that no EATL was
found in 143 cases of Japanese patients with primary
intestinal NHL. In this study, all 49 cases of T-cell intestinal
NHL had no history of celiac disease resulting in no EATL,
which may have been related to rare gluten intolerance in the
Asian population.
Different pathological subtypes of primary intestinal
NHL have significant differences in clinical features. In the
present study, more young patients were found with T-cell
type intestinal NHL compared to B-cell type intestinal
NHL, and these patients often had relatively poor general
states, hypoproteinemia, and B symptoms. In B-cell NHL,
intestinal obstruction is more common, which is consistent
with the report by Severin [22]. Perforation occurs more
easily in T-cell intestinal NHL than in B-cell lymphoma.
Severin [22] reported that in T-cell intestinal NHL, the
perforation rate was 13%, while the perforation rate was
5% in B-cell type intestinal NHL. In the 14 patients with
perforation, the T-cell type accounted for 92.5%. Ibrahim
[11] reported that the intestinal perforation rate was 6% in
66 cases of intestinal diffuse large B-cell lymphoma. In this
study, the perforation rate was 16.67% in T-cell lymphoma
and 13.24% in B-cell lymphoma, and the difference was
not statistically significant. The incidence of intestinal
perforation for B-cell intestinal NHL was higher than what
was previously reported.
Recent studies on primary gastric NHL have found that
non-surgical and surgical treatment may have the same effect
with no significant differences in overall survival. Surgery is
recommended for the treatment of complications and to
alleviate symptoms [7, 23–25]. However, preoperative diag-
nosis is difficult for intestinal NHL, especially when the NHL
is in the small intestine, and it often needs to be confirmed by
postoperative pathological examination. Patients with bowel
obstruction and intestinal perforation also need surgery.
Therefore, patients with primary intestinal NHL received
surgery with postoperative chemotherapy and/or radiotherapy
[26, 27]. Previous retrospective studies have found that
radical surgery was helpful for survival. Although the pro-
portion of patients receiving postoperative chemotherapy
varied, postoperative chemotherapy is recommended for
Med Oncol (2012) 29:227–234
highly malignant intestinal NHL [1, 11, 12, 28]. CHOP and
similar programs are often chosen. When compared to pri-
mary gastric NHL, treatment of intestinal NHL is less efficient
with chemotherapy, and the chemotherapy efficiency of T-cell
NHL is lower than the chemotherapy efficient of B-cell NHL
[22, 29]. For early primary intestinal NHL, postoperative
radiotherapy is still controversial, and some studies have
shown that patients with B-cell intestinal NHL do not need
radiotherapy [22]. There has not been a prospective clinical
trial on the treatment of intestinal NHL to test whether surgery
can be replaced by radiotherapy and chemotherapy or if
postoperative radiotherapy and chemotherapy are needed. In
our study, most patients received surgical treatment, but only
62.1% of patients had radical surgery. More patients were
received radical surgery in B-cell intestinal NHL compared to
T-cell intestinal NHL. Patients receiving chemotherapy after
surgery accounted for 66% of all the patients, and there was no
difference between B-cell intestinal NHL and T-cell intestinal
NHL.
Previous reports have shown that a five-year survival
rate of primary intestinal NHL is between 24 and 56% [1,
4, 8, 11, 26, 30], which is lower than the survival rate of
primary gastric NHL. Different clinical studies of single-
factor analyses have shown that age, T-cell type, clinical
stage, intestinal perforation, B symptoms, and no radical
surgery are considered as poor prognostic factors [1, 2, 8,
11, 26, 30]. In B-cell intestinal NHL, MALT has a good
prognosis with a 5-year survival rate [27, 31]. A few
studies with multi-factor analyses have been done, and
some have reported that late clinical stage, perforation,
T-cell type, and B symptoms are independent prognostic
factors [1, 2, 27]. In this study, the 1-year and 2-year
survival rate was 76.7, 58.6%, respectively. The single-
factor analysis showed that male, older than 60 years, PS
score above two, hypoalbuminemia, intestinal perforation,
T-cell derived NHL, stages III-IV, no radical surgery, and
no chemotherapy had a poor prognosis. In the survival
curves of B-cell intestinal NHL, the rate of overall sur-
vivals was lower than the results found in other studies [7,
20–22]. The probable reasons are that only 77 patients had
chemotherapy, 18 patients were lost, and the other 4
patients of B-cell intestinal NHL died from non-tumor
factors. Further multivariate analysis showed that gender,
pathological subtype and radical surgery were independent
prognostic factors.
As the incidence of primary intestinal NHL is relatively
low and the staging criteria are not uniform, a single
research center cannot accumulate enough cases. At pres-
ent, the treatment of primary gastric lymphoma and treat-
ment evaluation remains controversial. A multi-center,
multi-prospective, randomized and controlled clinical
study on primary intestinal lymphoma is needed for further
investigations.
233
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