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
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摘要
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 Hpcombined 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 Hpalone,12 cases were treated by eradication of Hpcombined radiotherapy,7 cases were treated by eradication of Hpcombined 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 stageⅠE1,10 cases of stageⅠE2,and 6 cases of stageⅡE1.Hpinfection was found to be 89.3%.The 1 year complete remission rate in the Hp eradication group and the Hperadication combined radiotherapy group or the Hperadication combined chemotherapy group were 77.8%,100%,and 83.3%,respectively.The recurrence rates after 5 years were 11.1%,0,and0,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 Hperadication group(P<0.05).Conclusion Hperadication 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.
Objective This paper attempts to investigate the efficacy of the Helicobacter pylori(Hp)eradication therapy,the eradication of Hpcombined 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 Hpalone,12 cases were treated by eradication of Hpcombined radiotherapy,7 cases were treated by eradication of Hpcombined 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 stageⅠE1,10 cases of stageⅠE2,and 6 cases of stageⅡE1.Hpinfection was found to be 89.3%.The 1 year complete remission rate in the Hp eradication group and the Hperadication combined radiotherapy group or the Hperadication combined chemotherapy group were 77.8%,100%,and 83.3%,respectively.The recurrence rates after 5 years were 11.1%,0,and0,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 Hperadication group(P<0.05).Conclusion Hperadication 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.
引文
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2陈小丽,季峰,吴加国.超声胃镜对38例原发性胃淋巴瘤的诊断优势和随访价值[J].中华消化杂志,2016,36(8):514-518.
3 El-Zahabi LM,Jamali FR,El-Hajj II,et al.The value of EUSin predicting the response of gastric mucosa-associated lymphoid tissue lymphoma to Helicobacter pylori eradication[J].Gastrointest Endosc,2007,65(1):89-96.
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5 National Comprehensive Cancer Network.NCCN clinical practice guidelines in oncology:B-cell lymphomas(version 3.2017)[EB/OL].https://www.nccn.org/professionals/physician_gls/pdf/b-cell.pdf.2017-06-27.
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9 Morgner A,Schmelz R,Thiede C,et al.Therapy of gastric mucosa associated lymphoid tissue lymphoma[J].World JGastroenterol,2007,13(26):3554-3566.
10张廷友,牛绍青,张玉晶.放疗在ⅠE/ⅡE期胃黏膜相关淋巴组织淋巴瘤中的预后价值评价[J].世界华人消化杂志,2016,24(6):923-927.
11 Yoon SS,Hochberg EP.Chemotherapy is an effective first line treatment for early stage gastric mucosa-associated lymphoid tissue lymphoma[J].Cancer Treat Rev,2006,32(2):139-143.
12 Kodera Y,Yamamura Y,Nakamura S,et al.The role of radical gastrectomy with systematic lymphadenectomy for the diagnosis and treatment of primary gastric lymphoma[J].Ann Surg,1998,227(1):45-50.
13 Raderer M,Streubel B,W9hrer S,et al.Successful antibiotic treatment of Helicobacter pylori negative gastric mucosa associated lymphoid tissue lymphomas[J].Gut,2006,55(5):616-618.
14 Dong G,Liu C,Ye H,et al.BCL10nuclear expression and t(11;18)(q21;q21)indicate nonresponsiveness to Helicobacter pylori eradication of Chinese primary gastric MALT lymphoma[J].Int J Hematol,2008,88(5):516-523.
15 Hancock BW,Qian W,Linch D,et al.Chlorambucil versus observation after anti-Helicobacter therapy in gastric MALTlymphomas:results of the international randomised LY03trial[J].Br J Haematol,2009,144(3):367-375.
2陈小丽,季峰,吴加国.超声胃镜对38例原发性胃淋巴瘤的诊断优势和随访价值[J].中华消化杂志,2016,36(8):514-518.
3 El-Zahabi LM,Jamali FR,El-Hajj II,et al.The value of EUSin predicting the response of gastric mucosa-associated lymphoid tissue lymphoma to Helicobacter pylori eradication[J].Gastrointest Endosc,2007,65(1):89-96.
4 Dawson IM,Cornes JS,Morson BC.Primary malignant lymphoid tumours of the intestinal tract.Report of 37cases with a study of factors influencing prognosis[J].Br J Surg,1961,49:80-89.
5 National Comprehensive Cancer Network.NCCN clinical practice guidelines in oncology:B-cell lymphomas(version 3.2017)[EB/OL].https://www.nccn.org/professionals/physician_gls/pdf/b-cell.pdf.2017-06-27.
6 Suekane H,Iida M,Yao T,et al.Endoscopic ultrasonography in primary gastric lymphoma:correlation with endoscopic and histologic findings[J].Gastrointest Endosc,1993,39(2):139-145.
7 Stathis A,Chini C,Bertoni F,et al.Long-term outcome following Helicobacter pylori eradication in a retrospective study of 105 patients with localized gastric marginal zone B-cell lymphoma of MALT type[J].Ann Oncol,2009,20(6):1086-1093.
8 Starostik P,Patzner J,Greiner A,et al.Gastric marginal zone B-cell lymphomas of MALT type develop along 2 distinct pathogenetic pathways[J].Blood,2002,99(1):3-9.
9 Morgner A,Schmelz R,Thiede C,et al.Therapy of gastric mucosa associated lymphoid tissue lymphoma[J].World JGastroenterol,2007,13(26):3554-3566.
10张廷友,牛绍青,张玉晶.放疗在ⅠE/ⅡE期胃黏膜相关淋巴组织淋巴瘤中的预后价值评价[J].世界华人消化杂志,2016,24(6):923-927.
11 Yoon SS,Hochberg EP.Chemotherapy is an effective first line treatment for early stage gastric mucosa-associated lymphoid tissue lymphoma[J].Cancer Treat Rev,2006,32(2):139-143.
12 Kodera Y,Yamamura Y,Nakamura S,et al.The role of radical gastrectomy with systematic lymphadenectomy for the diagnosis and treatment of primary gastric lymphoma[J].Ann Surg,1998,227(1):45-50.
13 Raderer M,Streubel B,W9hrer S,et al.Successful antibiotic treatment of Helicobacter pylori negative gastric mucosa associated lymphoid tissue lymphomas[J].Gut,2006,55(5):616-618.
14 Dong G,Liu C,Ye H,et al.BCL10nuclear expression and t(11;18)(q21;q21)indicate nonresponsiveness to Helicobacter pylori eradication of Chinese primary gastric MALT lymphoma[J].Int J Hematol,2008,88(5):516-523.
15 Hancock BW,Qian W,Linch D,et al.Chlorambucil versus observation after anti-Helicobacter therapy in gastric MALTlymphomas:results of the international randomised LY03trial[J].Br J Haematol,2009,144(3):367-375.