The Cancer Center at Memorial Hospital of Rhode Island, Pawtucket, RI 02860, USA.
Ann Oncol. 2013 May;24(5):1352-9. doi: 10.1093/annonc/mds644. Epub 2013 Jan 24.
Therapy for gastric marginal zone (MALT) lymphoma is largely based on single-arm trials. This observational study compared survival with radiotherapy, rituximab and combination chemoimmunotherapy in this disease.
Gastric MALT lymphoma cases diagnosed between 1997 and 2007 were selected from the Surveillance, Epidemiology and End Results-Medicare database. Propensity score analysis and competing risk models were used to compare survival in patients with stage IE treated with radiation or chemotherapy, and in patients of all stages treated with rituximab alone or with chemoimmunotherapy.
Among 1134 patients, 21% underwent radiation and 24% chemotherapy as initial treatment. In the balanced cohort of 347 patients with stage IE, radiotherapy alone was associated with a better cause-specific survival [hazard ratio (HR) 0.27, P < 0.001]. Patients receiving systemic therapy had better survival if it incorporated rituximab (HR 0.53, P = 0.017). After adjustment for confounding, the outcomes of those who received rituximab alone or combination chemoimmunotherapy were not statistically different (P = 0.14).
In elderly patients with stage IE gastric MALT lymphoma, radiotherapy was associated with lower risk of lymphoma-related death than chemotherapy. In those requiring systemic treatment, addition of cytotoxic chemotherapy to rituximab in the first-line regimen was not associated with improved survival.
胃黏膜相关边缘区（MALT）淋巴瘤的治疗主要基于单臂试验。本观察性研究比较了放疗、利妥昔单抗和联合化疗免疫治疗在该疾病中的生存情况。
从监测、流行病学和最终结果-医疗保险数据库中选择了 1997 年至 2007 年间诊断的胃 MALT 淋巴瘤病例。采用倾向评分分析和竞争风险模型比较了 IE 期接受放疗或化疗的患者、所有分期接受利妥昔单抗单药或联合化疗免疫治疗的患者的生存情况。
在 1134 例患者中，21%接受了放疗，24%接受了化疗作为初始治疗。在 IE 期的 347 例平衡队列中，单独放疗的特异性生存更好[风险比（HR）0.27，P<0.001]。如果系统治疗中包含利妥昔单抗，则患者的生存更好（HR 0.53，P=0.017）。在调整混杂因素后，接受利妥昔单抗单药或联合化疗免疫治疗的患者的结局没有统计学差异（P=0.14）。
在 IE 期胃 MALT 淋巴瘤的老年患者中，与化疗相比，放疗与淋巴瘤相关死亡风险较低。对于需要系统治疗的患者，在一线方案中添加细胞毒性化疗药物联合利妥昔单抗治疗与生存改善无关。
