TNM staging system may be superior to Lugano and Ann Arbor systems in predicting the overall survival of patients with primary gastrointestinal lymphoma

Abstract

Purpose: To assess the survival predicting value of TNM, Lugano, and Ann Arbor staging systems in patients with primary gastrointestinal lymphoma (PGL).

Methods: 101 patients with PGL were reviewed. All of them were staged according to TNM, Lugano, or Ann Arbor staging system. Five-year survival overall survival/OS rate was used as major clinical outcome. The prognostic value of different variables like depth of tumor infiltration (T), lymph node status (N), metastasis (M), sex, age, LDH, ECOG performance status (PS), subtypes, and tumor sites were assessed in relation to clinical outcome.

Results: The median follow-up time was 46.6 months (range 1.3-158.6). The estimated 5-year OS rate was 74.22%. In gastric lymphoma ,the 5-year OS rate was well correlated with stage in the TNM system (stage I 100.00%, stage II 87.18%, stage III 75.17%, and stage IV 16.67%. p<0.0001), but there were inverse 5-year OS or overlapped survival in the Lugano (81.48% in stage II, 85.71% in stage IIE) and Ann Arbor systems (69.47% in stage IIE, 66.67% in stage IIIE). In aggressive lymphomas, the 5-year OS of TNM stage I, stage II, stage III , and stage IV was 100.00%, 81.34%, 63.52%, and 16.00%, respectively (p=0.0002), but there were overlapped survival curves in Lugano and Ann Arbor systems. The 5-year OS of patients with T1 or T2 was significantly superior compared to patients with T3 or T4 (96.15 vs 67.92%, p=0.0087), and multivariate Cox analysis showed that T (p=0.0181) and M (p=0.0031) were the covariates prognostically significant for OS.

Conclusion: TNM staging system may be superior to Lugano and Ann Arbor system in predicting OS of patients with PGL.