Kuo S-H, Yeh K-H, Chen L-T, Lin C-W, Hsu P-N, Hsu C, Wu M-S, Tzeng Y-S, Tsai H-J, Wang H-P, Cheng A-L
1] Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan [2] Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan [3] Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan [4] Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
1] Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan [2] Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan [3] Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
Blood Cancer J. 2014 Jun 20;4(6):e220. doi: 10.1038/bcj.2014.40.
We recently showed that Helicobacter pylori (HP)-positive gastric 'pure' diffuse large B-cell lymphoma (DLBCL) may respond to HP eradication therapy. However, whether these HP-related 'pure' DLBCL of the stomach may differ fundamentally from those unrelated to HP remains unclear. In this study, we compared the clinicopathologic features of these two groups of patients who had been uniformly treated by conventional chemotherapy. Forty-six patients were designated HP-positive and 49 were HP-negative by conventional criteria. HP-positive patients had a lower International Prognostic Index score (0-1, 65% vs 43%, P=0.029), a lower clinical stage (I-IIE1, 70% vs 39%, P=0.003), a better tumor response to chemotherapy (complete pathologic response, 76% vs 47%, P=0.004) and significantly superior 5-year event-free survival (EFS) (71.7% vs 31.8%, P<0.001) and overall survival (OS) (76.1% vs 39.8%, P<0.001). To draw a closer biologic link with HP, HP-positive tumors were further examined for CagA expression in lymphoma cells. Compared with CagA-negative cases (n=16), CagA-positive cases (n=27) were associated with high phosphorylated SHP-2 expression (P=0.016), and even better 5-year EFS (85.2% vs 46.3%, P=0.002) and OS (88.9% vs 52.9%, P=0.003). HP-related gastric 'pure' DLBCL may be a distinct tumor entity, which is less aggressive, and responds better to conventional chemotherapy.
我们最近发现，幽门螺杆菌（HP）阳性的胃“纯”弥漫性大B细胞淋巴瘤（DLBCL）可能对HP根除治疗有反应。然而，这些与HP相关的胃“纯”DLBCL是否与那些与HP无关的DLBCL存在根本差异仍不清楚。在本研究中，我们比较了这两组接受传统化疗的患者的临床病理特征。按照传统标准，46例患者被判定为HP阳性，49例为HP阴性。HP阳性患者的国际预后指数评分较低（0 - 1分，65%对43%，P = 0.029），临床分期较低（I - IIE1期，70%对39%，P = 0.003），对化疗的肿瘤反应较好（完全病理缓解，76%对47%，P = 0.004），5年无事件生存率（EFS）显著更高（71.7%对31.8%，P < 0.001）以及总生存率（OS）更高（76.1%对39.8%，P < 0.001）。为了与HP建立更紧密的生物学联系，对HP阳性肿瘤的淋巴瘤细胞进一步检测CagA表达。与CagA阴性病例（n = 16）相比，CagA阳性病例（n = 27）与高磷酸化SHP - 2表达相关（P = 0.016），且5年EFS甚至更好（85.2%对46.3%，P = 0.002）以及OS更好（88.9%对52.9%，P = 0.003）。与HP相关的胃“纯”DLBCL可能是一种独特的肿瘤实体，侵袭性较小，对传统化疗反应更好。
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