胃黏膜相关淋巴样组织淋巴瘤42例临床分析

Gastric Mucosa-Associated Lymphoid Tissue Lymphoma: a Clinical Analysis of 42 Patients

目的:探讨胃黏膜相关淋巴样组织淋巴瘤的临床表现、病理特征和治疗方法。方法:回顾性分析1990年7月至2008年5月间42例胃MALT淋巴瘤的病理特征和临床分期等资料,并按治疗方式不同划分为单纯根除Hp组(7例)、单纯手术组(9例)、手术+根除Hp组(20例)、手术+放、化疗组(6例),对各治疗组随访结果使用Kaplan-Meier方法进行生存率分析,LogRank检验评估各组间的统计学差异。结果:全组患者均接受胃镜检查,确诊率26.2%(11/42),HP染色阳性率70.6%(24/34)。免疫表型分析证实全部为B细胞性淋巴瘤。全组Cotswolds改良Ann Arbor分期:Ⅰ E2期17例,ⅡE1期16例,ⅡE2期6例,ⅢE期2例,Ⅳ期1例。各组5年生存率分别为100%、83.7%、82.4%及43.0%(P=0.027)。结论:胃MALT淋巴瘤的临床表现和辅助检查均无明显特异性,故初治时接受手术治疗的患者较多病理确诊者可首选根除Hp治疗,疗效与手术无异;晚期患者可在术后选择放、化疗等综合治疗,但远期生存率相对较差。

Objective： Primary gastric lymphomas account for 4.6% of non-Hodgkin lymphomas （ NHL ）. Over the past several years, significant attention has been paid to the gastric mucosa-associated lymphoid tissues （ MALT ）, a low-grade gastric B cell lymphoma, due to a close correlation between the incidence of MALT and Helicobacter pylori infection. The aim of the present study was to discuss the clinical features, pathological diagnosis, and therapeutic regimen of gastric MALT lymphoma. Methods： Clinicopathologic features and data of clinical stages of 42 patients with gastric MALT lymphoma, who were admitted to Tianjin Medical University Cancer Institute and Hospital between July 1990 and May 2008, were retrospectively analyzed. The cases were divided according to the treatment administered, namely, 7 patients by H. pylori eradication, 9 by surgery, 20 by surgery plus H. pylori eradication, and 6 by surgery plus chemotherapy or radiotherapy. The Kaplan-Meier method was used to analyze the survival rates, and the Log rank test was performed to assess the statistical significance among the groups. Results： All patients received gastroscopy and biopsy. However, only 11 of the 42 patients （ 26.2% ） were pathologically confirmed. H. pylori strain was positive in 24 of 34 patients （ 70.6% ）. The results of the immtmophenotypic analysis confirmed these tumors to be B-cell lymphoma. Based on the Cotswolds modification of the Ann Arbor Staging System, 17 of the cases were at stage ⅠE2, 16 at stage ⅡE1, 6 at stage ⅡE2, two at stage ⅡE, and one at stage Ⅳ, respectively. Survival analysis indicated that the 5-year survival rates were 100%, 83.7%, 82.4%, and 43.0%, respectively, in the 4 groups （ P = 0.027 ）. Conclusion： There are no remarkable characteristics in the clinical manifestation and auxiliary examination of the gastric MALT lymphoma. Thus, very few patients received surgery at the initial treatment, choosing either Hp eradication or radiotherapy instead. Hp eradication should be recommended as the first-line therapy after a final diagnosis is made by pathology, because its clinical effects are equal to those of surgery. For a patient with advanced gastric MALT lymphoma, combined therapy, such as chemoradiotherapy, can be conducted after surgery. However, long-term survival rates may be relatively poor, compared with those of patients with early-stage lesions.