Yang Hyo-Joon, Lee Changhyun, Lim Seon Hee, Choi Ji Min, Yang Jong In, Chung Su Jin, Choi Seung Ho, Im Jong Pil, Kim Sang Gyun, Kim Joo Sung
Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.
J Gastroenterol Hepatol. 2016 Sep;31(9):1572-83. doi: 10.1111/jgh.13311.
The role of screening endoscopy in primary gastric lymphoma (PGL) has not been investigated. This study aimed to evaluate the clinical characteristics and outcomes of PGLs detected by screening endoscopy in the high prevalence area of Helicobacter pylori (H. pylori) infection.
This retrospective cohort study enrolled consecutive subjects who were diagnosed with PGL by endoscopic screening in Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea, between October 2003 and September 2013. The characteristics and outcome of screening-detected patients (screening group) were compared with consecutive subjects diagnosed with PGL in the outpatient clinic (outpatient group).
Of the 105 194 recipients of screening upper endoscopy, 52 (0.049%) were found to have PGL. The median age was 54.2 years (range 23-79), and 65.4% were women. The proportion of PGL to gastric malignancy was 12.1% (52/429) overall, but >30% (25/73) in middle-aged (40-59) women. PGLs in the screening group were more likely to be mucosa-associated lymphoid tissue lymphoma (98.1% vs 60.0%, P < 0.001) and treated with H. pylori eradication alone (90.0% vs 48.1%, P < 0.001) than those in the outpatient group. Moreover, the screening group showed better 5-year overall survival (100.0% vs 89.3%, P = 0.016) and progression-free survival (94.9% vs 83.4%, P = 0.040) than the outpatient group.
In Korea, a high prevalence area of H. pylori infection, PGL seems more prevalent than in Western countries. Endoscopic screening may help to detect early stage H. pylori-positive mucosa-associated lymphoid tissue lymphoma. A high index of suspicion is needed, especially in middle-aged women.
筛查性内镜检查在原发性胃淋巴瘤（PGL）中的作用尚未得到研究。本研究旨在评估在幽门螺杆菌（H. pylori）感染高发地区通过筛查性内镜检查发现的PGL的临床特征及预后。
本回顾性队列研究纳入了2003年10月至2013年9月期间在韩国首尔国立大学医院江南中心通过内镜筛查诊断为PGL的连续患者。将筛查发现的患者（筛查组）的特征及预后与门诊诊断为PGL的连续患者（门诊组）进行比较。
在105194例接受上消化道筛查性内镜检查的患者中，52例（0.049%）被发现患有PGL。中位年龄为54.2岁（范围23 - 79岁），65.4%为女性。PGL占胃恶性肿瘤的比例总体为12.1%（52/429），但在中年（40 - 59岁）女性中超过30%（25/73）。与门诊组相比，筛查组的PGL更可能为黏膜相关淋巴组织淋巴瘤（98.1%对60.0%，P < 0.001），且更常仅接受幽门螺杆菌根除治疗（90.0%对48.1%，P < 0.001）。此外，筛查组的5年总生存率（100.0%对89.3%，P = 0.016）和无进展生存率（94.9%对83.4%，P = 0.040）均优于门诊组。
在幽门螺杆菌感染高发的韩国，PGL似乎比西方国家更为普遍。内镜筛查可能有助于发现早期幽门螺杆菌阳性的黏膜相关淋巴组织淋巴瘤。尤其对于中年女性，需要高度怀疑。
