Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
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Prognostic Impact of Helicobacter pylori Infection and Eradication Therapy in Gastric Mucosa-associated Lymphoid Tissue Lymphoma

  • Park, Sang-Hyuk (Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center) ;
  • Chi, Hyun-Sook (Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center) ;
  • Park, Seo-Jin (Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center) ;
  • Jang, Seong-Soo (Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center) ;
  • Park, Chan-Jeoung (Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center) ;
  • Huh, Joo-Ryung (Department of Pathology, University of Ulsan College of Medicine and Asan Medical Center)
  • Received : 2010.04.26
  • Accepted : 2010.10.07
  • Published : 2010.12.01
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Abstract

Background : Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is associated with Helicobacter pylori infection and H. pylori eradication is used as its first-line therapy. However, controversies exist about the prognostic value of H. pylori infection in these patients. We evaluated the prognostic impact of H. pylori infection and eradication therapy in gastric MALT lymphoma. Methods : A total of 292 patients diagnosed with MALT lymphoma since 2000 were analysed. MALT lymphoma was diagnosed with tissue biopsy and H. pylori infection was diagnosed with hematoxylin-eosin and additional Warthin-Starry stains on tissue sections. Clinical variables such as bone marrow (BM) involvement, multiorgan involvement, tumor stage at diagnosis, and remission were obtained with retrospective review of electronic medical records. Results : Non-gastric MALT lymphoma patients showed higher multiorgan involvement rates (26.6% vs. 9.6%, P<0.001) and higher proportion of stage ${\geq}$3 (27.7% vs. 16.7%, P=0.029) than gastric cases. Regarding gastric MALT lymphoma, patients with H. pylori infection at diagnosis showed significantly less BM (2.1% vs. 21.8%, P<0.001) and multiorgan involvement rates (6.3% vs. 18.2%, P=0.011) than those without infection. But there was no significant difference in remission rates between them. In contrast, those with successful H. pylori eradication therapy showed significantly higher remission rates (81.0% vs. 30.8%, P<0.001) than those with failure. Conclusions : Non-gastric MALT lymphoma patients showed worse prognosis compared to gastric cases. As for remission rates in patients with gastric MALT lymphoma, successful H. pylori eradication therapy could be a good prognostic factor even if H. pylori infection was present at diagnosis.

배경 : 위에서 발생한 점막관련 림프조직 림프종(mucosaassociated lymphoid tissue lymphoma, MALT 림프종)은 Helicobacter pylori 감염과 연관되어 있으며 H. pylori 제균이 초기 치료로 사용되고 있다. 그러나 H. pylori 감염의 예후적 의미에 대해서는 문헌별로 차이가 있다. 저자들은 위에서 발생한 MALT 림프종에서 H. pylori 감염 및 제균 치료가 예후에 미치는 영향에 대한 분석을 실시하였다. 방법 : 2000년 이후 MALT 림프종으로 진단된 292명의 환자를 대상으로 하였다. MALT 림프종은 의심되는 부위에 대한 조직검사를 시행하여 진단하였고, H. pylori 감염은 조직 표본에 hematoxylin-eosin 및 추가적인 Warthin-Starry silver 염색을 시행하여 진단하였다. 골수침범, 다장기침범, 진단 시의 종양 병기 및 관해 등의 여러 임상적 변수들은 전자의무기록을 후향적으로 참고하여 얻었다. 결과 : 위 이외의 장기에서 발생한 MALT 림프종 환자에서 위에서 발생한 경우에 비해 다장기침범률이 높았으며(26.6% vs. 9.6%, P<0.001) 3기 이상의 진행된 종양 병기를 보이는 경우가 많았다(27.7% vs. 16.7%, P=0.029). 위 MALT 림프종에서 진단 당시 H. pylori 감염이 있었던 환자는 없었던 환자에 비해 골수침범률(2.1% vs. 21.8%, P<0.001) 및 다장기침범률(6.3% vs. 18.2%, P=0.011)이 유의하게 낮았으나 관해율에 있어서는 유의한 차이가 없었다. 대조적으로, H. pylori 제균 치료에 성공한 환자는 실패한 환자에 비해 관해율(81.0% vs. 30.8%, P<0.001)이 유의하게 높았다. 결론 : 위 이외의 장기에서 발생한 MALT 림프종 환자는 위에서 발생한 경우에 비해 예후가 불량하였다. 위 MALT 림프종환자에서 진단 당시 H. pylori 감염이 동반되었다 하더라도 제균 치료가 성공적으로 이루어질 경우 관해율에 대한 좋은 예후인자로 작용할 것으로 사료된다.

Keywords

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