利用超声胃镜评估3种早期胃黏膜相关淋巴组织淋巴瘤治疗方案的疗效

Efficacy of three treatment regimens for early gastric mucosa-associated lymphoid tissue lymphoma using endoscopic ultrasonography

目的利用超声胃镜技术评估单纯根除幽门螺杆菌(Hp)治疗、根除Hp联合放射治疗、根除Hp联合化学治疗这3种治疗方案对早期胃黏膜相关淋巴组织(MALT)淋巴瘤的疗效。方法回顾性分析复旦大学附属华山医院28例经超声内镜及病理诊断确诊的早期胃MALT淋巴瘤患者,其中单纯根除Hp治疗组9例,联合放射治疗组12例,联合化学治疗组7例。所有病例均应用超声胃镜随访,观察不同治疗方法的疗效。对3组患者的完全缓解率、5年生存率和复发率进行统计学分析。结果 28例MALT淋巴瘤患者超声内镜下发现浅表扩散型9例、弥漫浸润型7例、肿块型2例、混合型10例。其中ⅠE112例、ⅠE210例、ⅡE16例。Hp阳性占89.3%。单纯根除Hp治疗组、联合放射治疗组、联合化学治疗组1年后的完全缓解率分别为77.8%、100%和83.3%。3组5年后的复发率分别为11.1%、0和0。3组5年生存率均为100%。联合放射治疗组的无进展生存期高于单纯根除Hp组(P<0.05)。结论根除Hp联合放射治疗的疗效确切,耐受性好,可作为MALT淋巴瘤的一线治疗方案,化学治疗可作为一线治疗失败后的补救治疗。

Objective This paper attempts to investigate the efficacy of the Helicobacter pylori ( Hp ) eradication therapy, the eradication of Hp combined radiotherapy, and the eradication of Hp combined chemotherapy for early gastric mucosa-associated lymphoid tissue (MALT) lymphoma using endoscopic ultrasonography. Methods A retrospective study was conducted on 28 cases of early gastric MALT lymphoma in Huashan Hospital Affiliated to Fudan University, which was confirmed by endoscopic ultrasonography and pathological diagnosis. 9 cases were treated by eradication of Hp alone, 12 cases were treated by eradication of Hp combined radiotherapy, 7 cases were treated by eradication of Hp combined chemotherapy. All the cases were followed-up by endoscopic ultrasonography in order to observe the efficacies of different treatments. The complete response rate, 5-year survival rate, and recurrence rate were statistically analyzed in the three groups. Results According to the appearances under the endoscopic ultrasonography, 9 out of the 28 cases were the subtype of superficial diffusion, 7 cases belonged to the diffuse infiltration subtype, 2 cases belonged to the lump type, and 10 cases were of the mixed type. Altogether, there were 12 cases of stage ⅠE 1, 10 cases of stage ⅠE 2, and 6 cases of stage ⅡE 1. Hp infection was found to be 89.3%. The 1 year complete remission rate in the Hp eradication group and the Hp eradication combined radiotherapy group or the Hp eradication combined chemotherapy group were 77.8%, 100%, and 83.3%, respectively. The recurrence rates after 5 years were 11.1%, 0, and 0, respectively, in the three groups. The 5-year survival rate was 100% in all three groups. The progression-free survival time of the Hp eradication combined radiotherapy group was higher than that of the Hp eradication group ( P <0.05). Conclusion Hp eradication combined with radiotherapy is effective and well tolerated, which can be used as the first-line treatment for MALT lymphoma, and chemotherapy can be used as the remedial treatment after the failure of first-line treatment.