Departments of Radiation Oncology.
Medicine, University of Florida.
Am J Clin Oncol. 2020 Nov;43(11):770-775. doi: 10.1097/COC.0000000000000747.
Radiotherapy (RT) is an effective treatment for localized gastric mucosa-associated lymphoid tissue (MALT) lymphomas unresponsive to antibiotic therapy; however, irradiating the stomach can result in significant radiation to the heart, a risk factor for cardiac disease. We analyzed the Surveillance, Epidemiology, and End Results database to evaluate outcomes related to cardiac disease among patients treated with RT for stage I gastric MALT.
We identified adult patients treated between 1993 and 2014. The relationship between treatment modality (RT, chemotherapy, combination, and no treatment) and overall survival (OS), mucosa-associated lymphoid tissue-specific survival (MSS), non-mucosa-associated lymphoid tissue-specific survival (non-MSS), and cardiac-specific survival (CSS) was assessed using the Kaplan-Meier estimator and Cox proportional hazards analyses.
A total of 2996 patients (median follow-up, 5.6 y) were analyzed: 27.5% had received RT alone, 12.1% chemotherapy alone, 3.9% chemoradiotherapy, and 56.5% no/unknown treatment (including antibiotic therapy). Compared with RT alone, patients who received chemotherapy alone exhibited worse OS (hazard ratio [HR]: 1.67; 95% confidence interval [CI]: 1.32-2.10; P<0.001) and MSS (HR: 2.10; 95% CI: 1.36-3.23; P=0.001). Although CSS appeared worse in patients who received chemotherapy (HR: 1.56; 95% CI: 0.92-2.66; P=0.10), it was not statistically significant. When comparing orbital and gastric MALT patients, there was no significant difference in CSS (HR: 0.80; 95% CI: 0.49-1.31; P=0.38).
RT improved survival among patients with stage I gastric MALT without increasing the risk of cardiac death. Those with gastric MALT exhibited similar CSS to those with orbital MALT. Although we cannot analyze nonfatal cardiac toxicity, these results suggest that, absent antibiotic therapy, RT should remain first-line treatment for early-stage gastric MALT.
放疗（RT）是治疗对抗生素治疗无反应的局限性胃黏膜相关淋巴组织（MALT）淋巴瘤的有效方法；然而，照射胃部会导致心脏受到大量辐射，而心脏是心脏病的一个危险因素。我们分析了监测、流行病学和最终结果数据库，以评估接受 I 期胃 MALT 放射治疗的患者的心脏疾病相关结局。
我们确定了 1993 年至 2014 年期间接受治疗的成年患者。使用 Kaplan-Meier 估计器和 Cox 比例风险分析评估治疗方式（RT、化疗、联合治疗和未治疗）与总生存（OS）、黏膜相关淋巴组织特异性生存（MSS）、非黏膜相关淋巴组织特异性生存（non-MSS）和心脏特异性生存（CSS）之间的关系。
共分析了 2996 例患者（中位随访时间 5.6 年）：27.5%接受了单纯 RT，12.1%接受了单纯化疗，3.9%接受了放化疗，56.5%未接受治疗/未知治疗（包括抗生素治疗）。与单纯 RT 相比，接受单纯化疗的患者 OS 更差（风险比[HR]：1.67；95%置信区间[CI]：1.32-2.10；P<0.001）和 MSS 更差（HR：2.10；95% CI：1.36-3.23；P=0.001）。尽管化疗组 CSS 较差（HR：1.56；95% CI：0.92-2.66；P=0.10），但差异无统计学意义。当比较眶内和胃 MALT 患者时，CSS 无显著差异（HR：0.80；95% CI：0.49-1.31；P=0.38）。
RT 改善了 I 期胃 MALT 患者的生存，而不增加心脏死亡的风险。胃 MALT 患者的 CSS 与眶内 MALT 患者相似。尽管我们不能分析非致命性心脏毒性，但这些结果表明，在没有抗生素治疗的情况下，RT 应仍然是早期胃 MALT 的一线治疗方法。
