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胃I(E)期高级别黏膜相关淋巴组织淋巴瘤幽门螺杆菌根除治疗的前瞻性研究

Prospective study of Helicobacter pylori eradication therapy in stage I(E) high-grade mucosa-associated lymphoid tissue lymphoma of the stomach.

作者信息

Chen L T, Lin J T, Shyu R Y, Jan C M, Chen C L, Chiang I P, Liu S M, Su I J, Cheng A L

机构信息

Taiwan Cooperative Oncology Group, Division of Cancer Research, National Health Research Institutes, Taipei, Taiwan, ROC.

出版信息

J Clin Oncol. 2001 Nov 15;19(22):4245-51. doi: 10.1200/JCO.2001.19.22.4245.

Abstract

PURPOSE

High-grade mucosa-associated lymphoid tissue (MALT) lymphomas of the stomach are generally believed to be Helicobacter pylori-independent, autonomously growing tumors. However, anecdotal cases of regression of high-grade lymphomas after the cure of H pylori infection had been described. The present prospective study was conducted to evaluate the effect of anti-H pylori therapy in stage I(E) high-grade gastric MALT lymphomas.

PATIENTS AND METHODS

Sixteen patients with H pylori infection and stage I(E) gastric high-grade MALT lymphoma consented to a brief antibiotic therapy as first-line treatment from June 1995 through April 2000. Then, patients underwent intensive endoscopic follow-up examinations (+/- endoscopic ultrasonography) with biopsy to evaluate tumor response. Patients with significant improvement of gross lesions that accompanied regression of large cells were followed up without additional treatment. Patients without significant improvement were immediately referred to systemic chemotherapy.

RESULTS

Eradication of H pylori was achieved in 15 patients and was accompanied by rapid gross tumor regression and disappearance of large cells in 10. All 10 of these patients with early response had subsequent complete histologic remission of lymphoma. The complete remission rate was 62.5% (95% confidence interval, 35.8% to 89.1%). The response rate was not affected by the tumor grading (proportion of large blast cells within the tumor) but was adversely affected by the depth of tumor invasion. At a median follow-up of 43.5 months (range, 21.1 to 67.4 months), all 10 of these patients remained lymphoma-free. The median duration of complete response was 31.2 months (range, 14.4 to 49.1 months).

CONCLUSION

These results suggest that high-grade transformation is not necessarily associated with the loss of H pylori dependence in early-stage MALT lymphomas of the stomach.

摘要

目的

胃高级别黏膜相关淋巴组织(MALT)淋巴瘤通常被认为是与幽门螺杆菌无关的自主生长肿瘤。然而,已有幽门螺杆菌感染治愈后高级别淋巴瘤消退的个别病例报道。本前瞻性研究旨在评估抗幽门螺杆菌治疗对Ⅰ(E)期胃高级别MALT淋巴瘤的疗效。

患者与方法

1995年6月至2000年4月,16例幽门螺杆菌感染且患有Ⅰ(E)期胃高级别MALT淋巴瘤的患者同意接受短期抗生素治疗作为一线治疗。然后,患者接受强化内镜随访检查(±内镜超声检查)并活检以评估肿瘤反应。肉眼病变有显著改善且大细胞消退的患者无需额外治疗进行随访。无显著改善的患者立即接受全身化疗。

结果

15例患者实现了幽门螺杆菌根除,其中10例伴有肿瘤肉眼快速消退和大细胞消失。所有这10例早期反应的患者随后均实现了淋巴瘤组织学完全缓解。完全缓解率为62.5%(95%置信区间,35.8%至89.1%)。缓解率不受肿瘤分级(肿瘤内大母细胞比例)影响,但受肿瘤浸润深度的不利影响。在中位随访43.5个月(范围21.1至67.4个月)时,所有这10例患者均无淋巴瘤复发。完全缓解的中位持续时间为31.2个月(范围14.4至49.1个月)。

结论

这些结果表明,在胃早期MALT淋巴瘤中,高级别转化不一定与对幽门螺杆菌依赖性的丧失相关。

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