Park Won, Chang Sei Kyung, Yang Woo Ick, Ko Young Hyeh, Huh Seung Jae, Ahn Yong Chan, Suh Chang-Ok
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Int J Radiat Oncol Biol Phys. 2004 Apr 1;58(5):1480-6. doi: 10.1016/j.ijrobp.2003.09.002.
To provide a rationale for the use of local radiotherapy (RT) for the treatment of low-grade mucosa-associated lymphoid tissue lymphoma of the stomach (MLS). In addition, the clinicopathologic characteristics were analyzed.
The data of 72 patients with MLS, who underwent radical surgery between 1991 and 2001, were retrospectively reviewed. The depth of invasion into the gastric wall and the pattern of lymph node spread according to pathologic grade were analyzed.
The patient age range was 24-77 years (median, 51 years). Of the 72 patients, 45 (62.5%) had low-grade and 27 (37.5%) had high-grade MLS; 44 (61%) had Stage I and 28 (39%) Stage II. The tumors were confined to the mucosa or submucosa in 43 patients (58.9%). Sixty-seven percent of low-grade tumors and 48% of high-grade tumors were confined to the mucosa and submucosa. Lymph node involvement was identified in 24.4% of the low-grade MLS patients and 63.0% of the high-grade MLS patients. In the low-grade group, lymph node involvement was limited to the perigastric lymph nodes in all cases except for one. One patient with tumor infiltration beyond the serosa had extensive lymph node involvement into the paraaortic and omental lymph nodes.
Local RT to the stomach and regional lymphatics can be applied preferably instead of gastrectomy in patients with low-grade MLS who are negative for Helicobacter pylori or are refractory to anti-H. pylori therapy. The timing of RT and the exclusion criteria for RT should be determined in the future.
为局部放疗（RT）用于治疗胃低度黏膜相关淋巴组织淋巴瘤（MLS）提供理论依据。此外，对其临床病理特征进行分析。
回顾性分析1991年至2001年间接受根治性手术的72例MLS患者的数据。分析根据病理分级的胃壁浸润深度及淋巴结转移模式。
患者年龄范围为24 - 77岁（中位年龄51岁）。72例患者中，45例（62.5%）为低度MLS，27例（37.5%）为高度MLS；44例（61%）为Ⅰ期，28例（39%）为Ⅱ期。43例患者（58.9%）肿瘤局限于黏膜或黏膜下层。67%的低度肿瘤和48%的高度肿瘤局限于黏膜和黏膜下层。低度MLS患者中24.4%有淋巴结受累，高度MLS患者中63.0%有淋巴结受累。在低度组中，除1例患者外，所有病例的淋巴结受累均局限于胃周淋巴结。1例肿瘤浸润超过浆膜的患者有广泛的淋巴结转移至腹主动脉旁和网膜淋巴结。
对于幽门螺杆菌阴性或对抗幽门螺杆菌治疗无效的低度MLS患者，可优先采用胃部及区域淋巴管的局部放疗而非胃切除术。放疗时机及放疗排除标准有待未来确定。
