| Purpose: Primary gastric lymphoma is a highly heterogeneous tumor,and there is still no uniform treatment modality,and the therapeutic value of radiotherapy in primary gastric lymphoma remains undefined.The aim of this retrospective study was to evaluate the role of radiotherapy in the comprehensive treatment of patients with primary gastric lymphoma and to investigate the factors affecting the prognosis of gastric lymphoma.Methods: A total of 140 patients with primary gastric lymphoma who were diagnosed and treated by Nanjing Medical University Cancer Hospital from May2010 to December 2019 were retrospectively analyzed.Hp infection was detected by endoscopic biopsy or breath test.According to the pathological type,clinical stage,and subjective wishes of the patients,the treatments received by all patients included chemotherapy,radiotherapy,surgery,and anti-Hp therapy.The optimal cutoff value of radiotherapy dose parameters affecting prognosis was determined by the Youden index value calculated by ROC analysis.Survival curves for overall survival(OS)and progression-free survival(PFS)were obtained by the Kaplan–Meier method.Univariate analysis of patient prognostic indicators was performed using the log-rank test,and multivariate analysis was further performed using the Cox regression model based on the results of univariate analysis.Results:After the end of treatment,the complete remission rate was 69.2% and the objective remission rate was 84.9%.The complete response rates were 76% and57.1% in patients who received chemotherapy followed by radiotherapy and those who did not(P=0.022).The follow-up time of this study was 50 months(4-127months).The 5-year OS and PFS of all patients were 85.4% and 75.5%,respectively.The 5-year OS was 88.8% and 78.8%(P=0.127),and the 5-year PFS was 78.2% and68.8%(P=0.188)in patients who received chemotherapy followed by radiotherapy and those who did not,respectively.Chemotherapy followed by radiotherapy has a significant survival benefit for some patients,mainly including patients with Hp-negative and diffuse large B-cell tumors.The radiation dose parameter cutoff value calculated by ROC analysis was 38 Gy,and the 5-year OS was 97.4% and83.2%(P=0.046)and the 5-year PFS was 91.1% and 70.6%(P=0.028)in the low-dose(30.4Gy–38Gy)and high-dose(38Gy–50Gy)groups,respectively.The5-year OS of patients in the total gastric radiotherapy group and the local gastric tumor radiotherapy group were 94.8% and 76.2%(P=0.015),and the 5-year PFS were 85% and 66.5%(P=0.051),respectively.For adverse effects related to radiotherapy,it was well tolerated by patients.The results of univariate analysis showed that: ECOG score,clinical stage,IPI score,Hp status,LDH before treatment,hemoglobin level,and albumin level are important influencing factors of OS(P<0.05);ECOG score,clinical stage,pathological classification,IPI score,LDH before treatment,hemoglobin level,and albumin level are important influencing factors of PFS(P<0.05).Multivariate analysis indicated that LDH level and clinical stage were independent prognostic factors(P<0.05).Conclusion: The overall prognosis of primary gastric lymphoma is good,and LDH level and clinical stage are independent prognostic factors for OS and PFS.Consolidation radiotherapy after chemotherapy can improve the complete remission rate of patients,and there is a trend of benefit in long-term survival.Whether it can translate into survival benefit needs further study.Analysis suggests that consolidation radiotherapy has a good therapeutic value in the treatment of some primary gastric lymphomas and can significantly improve the survival of patients with Hp negative and diffuse large B-cell tumors.For patients treated with radiotherapy,low-dose whole stomach radiotherapy can bring survival benefit to patients. |
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