Kong Seong-Ho, Kim Min-A, Park Do-Joong, Lee Hyuk-Joon, Lee Hye-Seung, Kim Chul-Woo, Yang Han-Kwang, Heo Dae-Seog, Lee Kuhn-Uk, Choe Kuk-Jin
Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
World J Gastroenterol. 2004 Apr 15;10(8):1103-9. doi: 10.3748/wjg.v10.i8.1103.
To analyze the clinicopathologic characteristics of surgically resected gastric lymphoma patients.
We retrospectively analyzed 57 surgically resected gastric lymphoma patients, dividing them into 2 subgroups: Low grade MALToma (the LG group), High grade MALToma and Diffuse large B cell lymphoma (the HG group).
The numbers of patients were: 20 in the LG group, 37 in the HG group. The diagnostic rate of gastroscopy was 34.8% at primary diagnosis and 50% including differential diagnoses. The positive rates of H pylori were similar between the 2 groups (68% vs 77%). Multiple lesions were found in 19.3%. The proportion of mucosal and submucosal lesions was 80.0%(16/20) in the LG group, and 24.3%(9/37) in the HG group (P<0.001). Lymph node invasion rates were 10.5%(2/19) in the LG group and 44.1%(15/34) in the HG group (P=0.031). The numbers of recurred patients were none in the LG group, and 8 in the HG group. By univariant analysis, group (P=0.024) and TNM stage (stage I, II vs stages III, IV, P=0.002) were found to be the significant risk factors. There was a tendency of higher recurrence rate in the subtotal gastrectomy group than in the total gastrectomy group (P=0.05).
The HG groups had a more advanced stage and a higher recurrence rate than the LG group. Although there was no difference between subtotal and total gastrectomies, more careful assessments of multiplicities and radical resections with lymph node dissections seem to be needed because of multiplicity and LN invasion even in LG group.
分析手术切除的胃淋巴瘤患者的临床病理特征。
我们回顾性分析了57例手术切除的胃淋巴瘤患者,将他们分为2个亚组:低级别黏膜相关淋巴组织淋巴瘤(LG组)、高级别黏膜相关淋巴组织淋巴瘤和弥漫性大B细胞淋巴瘤(HG组)。
患者数量分别为:LG组20例,HG组37例。初次诊断时胃镜诊断率为34.8%,包括鉴别诊断时为50%。两组幽门螺杆菌阳性率相似(68%对77%)。19.3%发现有多处病变。LG组黏膜和黏膜下病变比例为80.0%(16/20),HG组为24.3%(9/37)(P<0.001)。LG组淋巴结侵犯率为10.5%(2/19),HG组为44.1%(15/34)(P=0.031)。LG组无复发患者,HG组有8例复发。单因素分析发现,分组(P=0.024)和TNM分期(Ⅰ、Ⅱ期对Ⅲ、Ⅳ期,P=0.002)是显著危险因素。胃次全切除组复发率有高于胃全切除组的趋势(P=0.05)。
HG组比LG组分期更晚,复发率更高。虽然胃次全切除术和胃全切除术之间无差异,但由于即使在LG组也存在多处病变和淋巴结侵犯,似乎需要更仔细地评估病变多处情况并进行淋巴结清扫的根治性切除。