Kochi Mitsugu, Fujii Masashi, Kanamori Noriaki, Kaiga Teruo, Takahashi Toru, Kobayashi Michiyo, Takayama Tadatoshi
Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
Hepatogastroenterology. 2007 Jun;54(76):1285-8.
BACKGROUND/AIMS: There are many controversies regarding the treatment for primary gastric non-Hodgkin's lymphoma (PGL). We hypothesized that preoperative chemotherapy and extensive surgery would improve patient survival in the treatment of early stage patients with PGL.
Between 1997 and 2001, we prospectively evaluated 10 patients with stage IE and IIE PGL. The histological diagnoses were established by endoscopic biopsies in all cases. All patients received preoperative chemotherapy, i.e. CHOP or MACOP-B. Upon the completion of chemotherapy, the extensive surgery including total gastrectomy, splenectomy, cholecystectomy, and paraaortic lymphadenectomy were performed. The response rates of preoperative chemotherapy and overall survival were analyzed.
All patients were still alive with no signs of recurrence with a median follow-up of 86 months (range, 40 to 102 months) after surgery. In all patients, microscopic examinations did not reveal residual lymphoma cells in the resected stomach or lymph nodes. Chemotherapy-related preoperative complications such as perforation or intestinal bleeding did not occur in any of the cases. Postoperative complications developed in 30% (3/10) of patients and consisted of 2 pancreatic fistulas, 3 intra-abdominal abscesses, and 1 anastomotic leak.
Primary chemotherapy alone without surgery may produce complete remission in Stage IE-IIE PGL.
背景/目的：关于原发性胃非霍奇金淋巴瘤（PGL）的治疗存在诸多争议。我们推测术前化疗及广泛手术可提高早期PGL患者的生存率。
1997年至2001年间，我们前瞻性评估了10例IE期和IIE期PGL患者。所有病例均通过内镜活检确立组织学诊断。所有患者均接受术前化疗，即CHOP或MACOP - B方案。化疗结束后，进行包括全胃切除术、脾切除术、胆囊切除术和腹主动脉旁淋巴结切除术在内的广泛手术。分析术前化疗的缓解率及总生存率。
所有患者术后中位随访86个月（范围40至102个月）时均存活且无复发迹象。所有患者中，显微镜检查未在切除的胃或淋巴结中发现残留淋巴瘤细胞。所有病例均未发生化疗相关的术前并发症，如穿孔或肠道出血。30%（3/10）的患者出现术后并发症，包括2例胰瘘、3例腹腔内脓肿和1例吻合口漏。
单纯术前化疗而不进行手术可能使IE - IIE期PGL患者达到完全缓解。
