Psyrri A, Papageorgiou S, Economopoulos T
Second Department of Internal Medicine Propaedeutic, Athens University Medical School, University General Hospital Attikon, Haidari, Greece.
Ann Oncol. 2008 Dec;19(12):1992-9. doi: 10.1093/annonc/mdn525. Epub 2008 Jul 22.
Gastrointestinal lymphoma is the most common form of extranodal lymphoma, accounting for 30%-40% of cases. The most commonly involved site is the stomach (60%-75% of cases), followed by the small bowel, ileum, cecum, colon and rectum. The most common histological subtypes are diffuse large B-cell lymphoma (DLBCL) and marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT). Helicobacter pylori infection has been implicated in the pathogenesis of MALT gastric lymphoma, but its role in gastric diffuse large B-cell non-Hodgkin's lymphoma (NHL) is controversial. The therapeutic approach for patients with gastric NHL has been revised over the last 10 years. Conservative treatment with anthracycline-based chemotherapy alone or in combination with involved-field radiotherapy has replaced gastrectomy as standard therapy in cases with DLBCL. Additionally, MALT lymphomas are mainly treated with antibiotics alone, which can induce lasting remissions in those cases associated with H. pylori infection. Nevertheless, various therapeutic aspects for primary gastric lymphomas are still controversial and several questions remain unanswered. Among others, the role of rituximab, consolidation radiotherapy as well as H. pylori eradication in histological aggressive subtypes warrants better clarification.
胃肠道淋巴瘤是结外淋巴瘤最常见的形式，占病例的30%-40%。最常累及的部位是胃（占病例的60%-75%），其次是小肠、回肠、盲肠、结肠和直肠。最常见的组织学亚型是弥漫性大B细胞淋巴瘤（DLBCL）和黏膜相关淋巴组织边缘区B细胞淋巴瘤（MALT）。幽门螺杆菌感染与MALT胃淋巴瘤的发病机制有关，但其在胃弥漫性大B细胞非霍奇金淋巴瘤（NHL）中的作用存在争议。在过去10年中，胃NHL患者的治疗方法已经修订。对于DLBCL病例，单独使用以蒽环类为基础的化疗或联合受累野放疗的保守治疗已取代胃切除术成为标准治疗方法。此外，MALT淋巴瘤主要单独用抗生素治疗，这可使那些与幽门螺杆菌感染相关的病例获得持久缓解。然而，原发性胃淋巴瘤的各种治疗方面仍存在争议，一些问题仍未得到解答。其中，利妥昔单抗、巩固放疗以及幽门螺杆菌根除在组织学侵袭性亚型中的作用有待进一步明确。
