Evaluation of the clinical characteristics, management, and prognosis of 103 patients with gastric mucosa-associated lymphoid tissue lymphoma

Li,Xiaowu; Wang,Xiang; Zhan,Zhongli; Zhang,Lianyu; Sun,Baochun; Zhang,Yizhuo

doi:10.3892/ol.2016.4124

Evaluation of the clinical characteristics, management, and prognosis of 103 patients with gastric mucosa-associated lymphoid tissue lymphoma

Authors:
- Xiaowu Li
- Xiang Wang
- Zhongli Zhan
- Lianyu Zhang
- Baochun Sun
- Yizhuo Zhang
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Affiliations: Department of Medical Oncology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China, Department of Pathology, Tianjin Cancer Institute and Hospital, Tianjin 300060, P.R. China, Department of Hematology, Tianjin Cancer Institute and Hospital, Tianjin 300060, P.R. China
Published online on: January 19, 2016 https://doi.org/10.3892/ol.2016.4124
Pages: 1713-1718
Copyright: © Li et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The diagnosis of gastric mucosa-associated lymphoid tissue (MALT) lymphoma is difficult owing to its non-specific symptoms and various endoscopic findings. Treatments such as radiotherapy (RT) for localized and chemotherapy (CT) for advanced stages of the disease are employed. The aim of the present study was to examine the clinical characteristics and prognostic factors of Helicobacter pylori (H. pylori) eradication (HPE) in patients with gastric MALT lymphoma. The medical records of 103 patients with gastric MALT lymphoma for the period 2001‑2013, were analyzed. The 103 median age of the patients was 53 years and the male to female ratio was 1:1. Serum lactate dehydrogenase and β2‑microglobulin were within normal range. Macroscopically, the most commonly involved site was the antrum, followed by the corpus and fundus. A total of 97 patients (94%) tested positive for H. pylori. Forty patients (39%) had stage I, 35 patients (35%) had local or distant nodal involvement, 20 of 103 patients had stage IIIE (19%) and 8 of 103 patients had stage IV (7%) disease. Complete remission, after HPE, was achieved in 54 of the 69 patients (78%) that were H. pylori‑positive and in 2 of the 4 patients (50%) that were H. pylori‑negative. HPE had a superior trend in the H. pylori‑positive patients although no significant difference was identified in the two groups (p=0.194). In patients with advanced disease, the 5‑year progression‑free survival (PFS) and overall survival (OS) estimates were significantly improved for patients receiving HPE with CT or RT than those receiving CT or RT (p=0.046 and 0.035, respectively). The multivariate analysis revealed that, the advanced stages were independently associated with shorter PFS, and the modified‑International Prognostic Index (m‑IPI) (≥2) was associated with shorter OS. In conclusion, gastric MALT lymphoma had a favorable outcome with a high OS rate. HPE was an effective treatment for gastric MALT lymphoma. The patients with advanced stages and m-IPI (≥2) had a much worse prognosis.

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1	Zucca E and Cavalli F: Extranodal lymphomas. Ann Oncol. 11(Suppl 3): 219–222. 2000. View Article : Google Scholar : PubMed/NCBI
2	Du MQ and Atherton JC: Molecular subtyping of gastric MALT lymphomas: Implications for prognosis and management. Gut. 55:886–893. 2006. View Article : Google Scholar : PubMed/NCBI
3	Psyrri A, Papageorgiou S and Economopoulos T: Primary extranodal lymphomas of stomach: clinical presentation, diagnostic pitfalls and management. Ann Oncol. 19:1992–1999. 2008. View Article : Google Scholar : PubMed/NCBI
4	Zullo A, Hassan C, Andriani A, Cristofari F, De Francesco V, Ierardi E, Tomao S, Morini S and Vaira D: Eradication therapy for Helicobacter pylori in patients with gastric MALT lymphoma: a pooled data analysis. Am J Gastroenterol. 104:1932–1937, quiz 1938. 2009. View Article : Google Scholar : PubMed/NCBI
5	Ruskoné-Fourmestraux A, Fischbach W, Aleman BM, Boot H, Du MQ, Megraud F, Montalban C, Raderer M, Savio A and Wotherspoon A: EGILS group: EGILS consensus report. Gastric extranodal marginal zone B-cell lymphoma of MALT. Gut. 60:747–758. 2011. View Article : Google Scholar : PubMed/NCBI
6	Radaszkiewicz T, Dragosics B and Bauer P: Gastrointestinal malignant lymphomas of the mucosa-associated lymphoid tissue: Factors relevant to prognosis. Gastroenterology. 102:1628–1638. 1992.PubMed/NCBI
7	Ruskoné-Fourmestraux A, Aegerter P, Delmer A, Brousse N, Galian A and Rambaud JC: Primary digestive tract lymphoma: a prospective multicentric study of 91 patients. Groupe d'Etude des Lymphomes Digestifs. Gastroenterology. 105:1662–1671. 1993.PubMed/NCBI
8	Liu H, Ye H, Ruskone-Fourmestraux A, De Jong D, Pileri S, Thiede C, Lavergne A, Boot H, Caletti G, Wündisch T, et al: T(11;18) is a marker for all stage gastric MALT lymphomas that will not respond to H. pylori eradication. Gastroenterology. 122:1286–1294. 2002. View Article : Google Scholar : PubMed/NCBI
9	Yeh KH, Kuo SH, Chen LT, Mao TL, Doong SL, Wu MS, Hsu HC, Tzeng YS, Chen CL, Lin JT, et al: Nuclear expression of BCL10 or nuclear factor kappa B helps predict Helicobacter pylori-independent status of low-grade gastric mucosa-associated lymphoid tissue lymphomas with or without t(11;18)(q21;q21). Blood. 106:1037–1041. 2005. View Article : Google Scholar : PubMed/NCBI
10	Tomonaga M: Outline and direction of revised WHO classification of Tumors of Haematopoietic and Lymphoid Tissues. Rinsho Ketsueki. 50:1401–1406. 2009.(In Japanese). PubMed/NCBI
11	Rohatiner A, d'Amore F, Coiffier B, Crowther D, Gospodarowicz M, Isaacson P, Lister TA, Norton A, Salem P, Shipp M, et al: Report on a workshop convened to discuss the pathological and staging classifications of gastrointestinal tract lymphoma. Ann Oncol. 5:397–400. 1994.PubMed/NCBI
12	Wotherspoon AC, Doglioni C, Diss TC, Pan L, Moschini A, de Boni M and Isaacson PG: Regression of primary low-grade B-cell gastric lymphoma of mucosa-associated lymphoid tissue type after eradication of Helicobacter pylori. Lancet. 342:575–577. 1993. View Article : Google Scholar : PubMed/NCBI
13	Nakamura S, Matsumoto T, Iida M, Yao T and Tsuneyoshi M: Primary gastrointestinal lymphoma in Japan: a clinicopathologic analysis of 455 patients with special reference to its time trends. Cancer. 97:2462–2473. 2003. View Article : Google Scholar : PubMed/NCBI
14	Kolve M, Fischbach W, Greiner A and Wilms K: German Gastrointestinal Lymphoma Study Group: Differences in endoscopic and clinicopathological features of primary and secondary gastric non-Hodgkin's lymphoma. Gastrointest Endosc. 49:307–315. 1999. View Article : Google Scholar : PubMed/NCBI
15	Zullo A, Hassan C, Cristofari F, Andriani A, De Francesco V, Ierardi E, Tomao S, Stolte M, Morini S and Vaira D: Effects of Helicobacter pylori eradication on early stage gastric mucosa-associated lymphoid tissue lymphoma. Clin Gastroenterol Hepatol. 8:105–110. 2010. View Article : Google Scholar : PubMed/NCBI
16	Wündisch T, Thiede C, Morgner A, Dempfle A, Günther A, Liu H, Ye H, Du MQ, Kim TD, Bayerdörffer E, et al: Long-term follow-up of gastric MALT lymphoma after Helicobacter pylori eradication. J Clin Oncol. 23:8018–8024. 2005. View Article : Google Scholar : PubMed/NCBI
17	Fischbach W, Goebeler ME, Ruskone-Fourmestraux A, Wündisch T, Neubauer A, Raderer M and Savio A: EGILS (European Gastro-Intestinal Lymphoma Study) Group: Most patients with minimal histological residuals of gastric MALT lymphoma after successful eradication of Helicobacter pylori can be managed safely by a watch and wait strategy: experience from a large international series. Gut. 56:1685–1687. 2007. View Article : Google Scholar : PubMed/NCBI
18	Vivas S, de Morales Ruiz JM, Fernandez M, Hernando M, Herrero B, Casqueiro J and Gutierrez S: Age-related clinical, serological, and histopathological features of celiac disease. Am J Gastroenterol. 103:2360–2365, quiz 2366. 2008. View Article : Google Scholar : PubMed/NCBI
19	Raderer M, Streubel B, Wöhrer S, Häfner M and Chott A: Successful antibiotic treatment of Helicobacter pylori negative gastric mucosa associated lymphoid tissue lymphomas. Gut. 55:616–618. 2006. View Article : Google Scholar : PubMed/NCBI
20	Morgner A, Lehn N, Andersen LP, Thiede C, Bennedsen M, Trebesius K, Neubauer B, Neubauer A, Stolte M and Bayerdörffer E: Helicobacter heilmannii-associated primary gastric low-grade MALT lymphoma: Complete remission after curing the infection. Gastroenterology. 118:821–828. 2000. View Article : Google Scholar : PubMed/NCBI
21	Steinbach G, Ford R, Glober G, Sample D, Hagemeister FB, Lynch PM, McLaughlin PW, Rodriguez MA, Romaguera JE, Sarris AH, et al: Antibiotic treatment of gastric lymphoma of mucosa-associated lymphoid tissue. An uncontrolled trial. Ann Intern Med. 131:88–95. 1999. View Article : Google Scholar : PubMed/NCBI
22	Zucca E, Copie-Bergman C, Ricardi U, Thieblemont C, Raderer M and Ladetto M: ESMO Guidelines Working Group: Gastric marginal zone lymphoma of MALT type: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 24(Suppl 6): vi144–vi148. 2013. View Article : Google Scholar : PubMed/NCBI
23	Wirth A, Gospodarowicz M, Aleman BM, Bressel M, Ng A, Chao M, Hoppe RT, Thieblemont C, Tsang R, Moser L, et al: Long-term outcome for gastric marginal zone lymphoma treated with radiotherapy: a retrospective, multi-centre, International Extranodal Lymphoma Study Group study. Ann Oncol. 24:1344–1351. 2013. View Article : Google Scholar : PubMed/NCBI
24	Cogliatti SB, Schmid U, Schumacher U, Eckert F, Hansmann ML, Hedderich J, Takahashi H and Lennert K: Primary B-cell gastric lymphoma: a clinicopathological study of 145 patients. Gastroenterology. 101:1159–1170. 1991.PubMed/NCBI
25	Lima KS, Albuquerque W, Arantes VN, Drummond-Lage AP and Coelho LG: Helicobacter pylori and t(11;18)(q21;q21) translocation in gastric malt lymphoma. Arq Gastroenterol. 51:84–89. 2014. View Article : Google Scholar : PubMed/NCBI
26	Cortelazzo S, Rossi A, Roggero F, Oldani E, Zucca E, Tondini C, Ambrosetti A, Pasini F, Pinotti G, Bertini M, et al: International Extranodal Lymphoma Study Group (IELSG): Stage-modified international prognostic index effectively predicts clinical outcome of localized primary gastric diffuse large B-cell lymphoma. Ann Oncol. 10:1433–1440. 1999. View Article : Google Scholar : PubMed/NCBI
27	Leopardo D, Di Lorenzo G, De Renzo A, Federico P, Luponio S, Buonerba C, Matano E, Merola G, Imbimbo M, Montesarchio E, et al: Efficacy of rituximab in gastric diffuse large B cell lymphoma patients. World J Gastroenterol. 16:2526–2530. 2010. View Article : Google Scholar : PubMed/NCBI
28	Medina-Franco H, Germes SS and Maldonado CL: Prognostic factors in primary gastric lymphoma. Ann Surg Oncol. 14:2239–2245. 2007. View Article : Google Scholar : PubMed/NCBI
29	Ranaldi R, Goteri G, Baccarini MG, Mannello B and Bearzi I: A clinicopathological study of 152 surgically treated primary gastric lymphomas with survival analysis of 109 high grade tumours. J Clin Pathol. 55:346–351. 2002. View Article : Google Scholar : PubMed/NCBI