Cavanna Luigi, Pagani Raffaella, Seghini Pietro, Zangrandi Adriano, Paties Carlo
Medical Oncology-Hematology Department, Hospital of Piacenza, 29100 Piacenza, Italy.
World J Surg Oncol. 2008 Mar 19;6:35. doi: 10.1186/1477-7819-6-35.
Treatment of primary gastric diffuse large B-cell lymphoma is still controversial. The treatment of localized disease was based on surgery alone, or followed by chemotherapy and/or radiotherapy. High-grade gastric lymphomas are generally believed to be Helicobacter pylori (HP)-independent growing tumors. However a few cases of regression of high-grade gastric lymphomas after the cure of Helicobacter pylori infection had been described.
We report here a case with primary diffuse large B-cell lymphoma that showed a complete pathologic remission after HP eradication and we reviewed the literature. A computerized literature reach through Medline, Cancerlit and Embase were performed, applying the words: high grade gastric lymphoma, or diffuse large B cell, MALT gastric lymphoma, DLBCLL (MALT) lymphoma and Helicobacter. Articles and abstracts were also identified by back-referencing from original and relevant papers. Selected for the present review were papers published in English before January 2007.
Forty two cases of primary high grade gastric lymphoma that regressed with anti HP treatment were found. There were anecdotal cases reported and patients belonging to prospective studies; four trials studied the effect of eradication of Helicobacter pylori as first line therapy in high grade gastric lymphoma: 22 of a total of 38 enrolled patients obtained complete remission. Depth of gastric wall infiltration and clinical stage were important factors to predict the response to antibiotic therapy. Our case and the review of the literature show that high-grade transformation is not necessarily associated with the loss HP dependence. In early stage, for high-grade B-cell HP-positive gastric lymphomas, given the limited toxicity of anti-HP therapy, this treatment may be considered as one of the first line treatment options.
原发性胃弥漫性大B细胞淋巴瘤的治疗仍存在争议。局限性疾病的治疗基于单纯手术，或术后进行化疗和/或放疗。高级别胃淋巴瘤一般被认为是不依赖幽门螺杆菌（HP）生长的肿瘤。然而，已有少数高级别胃淋巴瘤在幽门螺杆菌感染治愈后出现消退的病例报道。
我们在此报告一例原发性弥漫性大B细胞淋巴瘤患者，在根除幽门螺杆菌后实现了完全病理缓解，并对相关文献进行了回顾。通过医学文献数据库（Medline）、癌症数据库（Cancerlit）和荷兰医学文摘数据库（Embase）进行了计算机化文献检索，检索词为：高级别胃淋巴瘤、弥漫性大B细胞、胃黏膜相关淋巴组织淋巴瘤、弥漫性大B细胞淋巴瘤（黏膜相关淋巴组织型）和幽门螺杆菌。还通过对原始及相关论文的参考文献回溯来识别文章和摘要。本次综述选取了2007年1月之前发表的英文论文。
共发现42例经抗HP治疗后病情缓解的原发性高级别胃淋巴瘤病例。既有个案报道，也有前瞻性研究中的患者；四项试验研究了根除幽门螺杆菌作为高级别胃淋巴瘤一线治疗的效果：38例入组患者中共有22例获得完全缓解。胃壁浸润深度和临床分期是预测对抗生素治疗反应的重要因素。我们的病例及文献回顾表明，高级别转化不一定与失去对HP的依赖性相关。在早期，对于高级别B细胞HP阳性胃淋巴瘤，鉴于抗HP治疗毒性有限，该治疗可被视为一线治疗选择之一。
