幽门螺杆菌感染阴性的MALT的胃边缘区B细胞淋巴瘤患者的预后良好。

背景：幽门螺杆菌根除治疗在胃黏膜相关性淋巴样组织淋巴瘤（MALT）患者中被推荐作为一线疗法。但是对于HP阴性的MALT患者的治疗和临床过程观察的相关报道比较少。

目的：评估幽门螺旋杆菌阴性的胃MALT淋巴瘤患者的治疗结果。

方法：该研究对21例（13男8女;平均年龄63.9年，范围43 - 80）Hp阴性MALT患者进行了回顾性分析。通过组织学检查，快速尿素酶试验，或¹³C尿素呼气试验以及血清学检查等方法鉴定HP的阴性结果。随访时间为56.4（5 - 142）个月。

结果：

有10例患者接受了HP根除治疗，这10例患者中4例在接受Hp根除治疗后未再接受其他治疗，另外6例患者后续接受了手术、放疗、化疗等治疗。此外的11例未接受了HP根除治疗的患者中，3例接受了放疗，1例化疗，2例口服PPIs治疗,4例未接受一线治疗，2例未接受作为二线疗法的放疗，1例治疗情况不明。21例患者中13例患者完全缓解，7例患者显示部分组织残留。总体和无病生存率分别为95％和90％。

结论：HP阴性MALT患者具有较好的预后。研究者支持对MALT淋巴瘤微小组织学残留的患者实行初始幽门螺杆菌根除治疗和之后的“观察-等待”结合的治疗策略。对于对根除治疗无效的患者也可通过放化疗达到成功治疗的目的。

译者小结：研究者通过小样本的幽门螺杆菌阴性的MALT淋巴瘤患者治疗的回顾性分析，得到其多数预后较好的结论。并推荐初始根除细菌治疗+随访观察的治疗策略。作者认为即使对根除治疗无效的病例，放化疗依然有效。

Z Gastroenterol. 2014 Dec;52(12):1389-1393. Epub 2014 Dec 4.

Patients with Helicobacter pylori negative gastric marginal zone b-cell lymphoma (MZBCL) of MALT have a good prognosis.

Al-Taie O¹, Al-Taie E¹, Fischbach W².

Author information

Abstract

Background: In current guidelines H. pylori eradication is recommended as first-line therapy in patients with gastric MALT lymphoma irrespective of stage and H. pylori status. However, data on treatment and clinical course of patients with H. pylori negative MALT lymphoma are rare. Aim: To evaluate therapeutical results in patients with H. pylori negative gastric MALT lymphoma. Methods: 21 patients (13 male and 8 female; 63.9 years, range 43 - 80) with gastric MALT lymphoma were analysed retrospectively on the basis of medical reports in all cases and repeated outpatient visits at our center in 17 cases. H. pylori infection was excluded by negative histology, rapid urease test, or C13 urease breath test, and serology in all cases. Follow-up was 56.4 (5 - 142) months. Results: Ten of 21 patients were treated with H. pylori eradication, and four of them received no further therapy. The other six patients underwent surgery, chemotherapy, and radiation, after eradication therapy. Those eleven patients without H. pylori eradication received radiation (n = 3), chemotherapy (n = 1), PPIs (n = 2), no treatment (n = 4) as first-line and radiation (n = 2) as second-line therapy while initial therapy remained unknown in one case. 13 patients (61.9 %) reached complete remission of lymphoma, and seven patients (33.3 %) showed minimal histological residuals. Overall and disease-free survival was found in 95 % and 90 %, respectively. Conclusion: Patients with H. pylori negative gastric MALT lymphoma have a good prognosis. We favor initial H. pylori eradication therapy and a watch-and-wait strategy in case of minimal histological residuals of MALT lymphoma. Non-responders to eradication therapy can be successfully treated by radiation and chemotherapy.