Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Gut. 2012 Apr;61(4):507-13. doi: 10.1136/gutjnl-2011-300495. Epub 2011 Sep 2.
A multicentre cohort follow-up study of a large number of patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma was conducted to elucidate the long-term outcome of the disease after Helicobacter pylori eradication.
420 patients with gastric low-grade MALT lymphoma who had undergone successful H pylori eradication and been followed up for at least 3 years were registered from 21 participating institutes. Responders to treatment were defined as patients whose post-treatment biopsies showed complete histological response (ChR) or probable minimal residual disease (pMRD). Treatment failure was defined as the status of progressive disease or lymphoma relapse after ChR/pMRD.
323 patients (77%) responded to H pylori eradication. A logistic regression analysis showed that absence of H pylori, submucosal invasion determined by endoscopic ultrasonography and t(11;18)/API2-MALT1 were independent predictors of resistance to H pylori eradication. During the follow-up periods ranging from 3.0 to 14.6 years (mean 6.5 years, median 6.04 years), the disease relapsed in 10 of 323 responders (3.1%) while progressive disease was found in 27 of 97 non-responders (27%). Thus, 37 of 420 patients (8.8%) were regarded as treatment failures. Of these 37 patients, transformation into diffuse large B cell lymphoma occurred in nine patients. Among the non-responders and relapsed patients, 17 patients were subjected to a 'watch and wait' strategy while 90 patients underwent second-line treatments including radiotherapy (n=49), chemotherapy (n=26), surgical resection (n=6), chemoradiotherapy (n=5), antibiotic treatment (n=2), rituximab monotherapy (n=1) or endoscopic resection (n=1). Probabilities of freedom from treatment failure, overall survival and event-free survival after 10 years were 90%, 95% and 86%, respectively. Cox multivariate analysis revealed endoscopic non-superficial type to be an independent prognostic factor for adverse freedom from treatment failure, overall survival and event-free survival.
The excellent long-term outcome of gastric MALT lymphoma after H pylori eradication was confirmed by this large-scale follow-up study.
通过对大量胃黏膜相关淋巴组织（MALT）淋巴瘤患者的多中心队列随访研究，阐明幽门螺杆菌（H. pylori）根除后该病的长期转归。
从 21 家参与机构中登记了 420 例经成功 H. pylori 根除治疗且随访至少 3 年的胃低级别 MALT 淋巴瘤患者。治疗应答者定义为治疗后活检显示完全组织学应答（ChR）或可能的微小残留疾病（pMRD）的患者。治疗失败定义为 ChR/pMRD 后疾病进展或淋巴瘤复发的状态。
323 例（77%）患者对 H. pylori 根除治疗有应答。logistic 回归分析显示，H. pylori 阴性、内镜超声检查确定的黏膜下浸润和 t（11；18）/API2-MALT1 是 H. pylori 根除耐药的独立预测因素。在 3.0 至 14.6 年（平均 6.5 年，中位数 6.04 年）的随访期间，323 例应答者中有 10 例（3.1%）疾病复发，97 例无应答者中有 27 例（27%）发现疾病进展。因此，420 例患者中有 37 例（8.8%）被认为是治疗失败。在这 37 例患者中，9 例转化为弥漫性大 B 细胞淋巴瘤。在无应答者和复发者中，17 例患者采用“观察等待”策略，90 例患者接受二线治疗，包括放疗（n=49）、化疗（n=26）、手术切除（n=6）、放化疗（n=5）、抗生素治疗（n=2）、利妥昔单抗单药治疗（n=1）或内镜下切除（n=1）。10 年后无治疗失败、总生存和无事件生存的概率分别为 90%、95%和 86%。Cox 多因素分析显示，内镜非浅表型是无治疗失败、总生存和无事件生存不良的独立预后因素。
本大规模随访研究证实了胃 MALT 淋巴瘤在 H. pylori 根除后的良好长期转归。
