DOI QR코드

DOI QR Code

Long-term Outcomes and Prognostic Factors of Gastric MALT Lymphoma

  • Jae Yeon Sim (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Hyun Soo Chung (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Sang Gyun Kim (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Soo Jeong Cho (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Bo Kyung Kim (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Jun Shik Hong (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • In Ho Kim (Department of Internal Medicine, Seoul National University College of Medicine)
  • Received : 2024.05.20
  • Accepted : 2024.08.12
  • Published : 2024.10.01

Abstract

Purpose: This study aimed to evaluate the long-term prognosis of patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma, including overall survival (OS), remission, and factors associated with an aggressive disease course. Materials and Methods: Medical records of 153 patients diagnosed with gastric MALT lymphoma between 2013 and 2020 were retrospectively reviewed. Patients experiencing relapse, progression, high-grade transformation, or residual diseasewere included in the aggressive group and were compared with those in the indolent group. Additionally, the endoscopic findings of Helicobacter pylori-negative patients were reviewed. Results: Patient characteristics were as follows: mean age (56.9±11.2 years), sex (male, 51.0%), H. pylori infection (positive, 79.7%), endoscopic location (distal, 89.5%), endoscopic feature (superficial, 89.5%), clinical stage (stage I, 92.8%), invasion depth by endoscopic ultrasound (mucosa, n=115, 75.7%), and bone marrow result (no involvement, n=77, 100.0%). The median follow-up period was 59 months (mean, 61; range, 36-124) and the continuous remission period (n=149) was 51 months (mean, 50; range, 3-112). The 5-year survival rate was 97.7% while the 5-year continuous remission was 88.3%. Factors associated with the patients in the aggressive group were old age, sex(male), and clinical stage II or higher. H. pylori-negative patients' endoscopy revealed a high incidence of atrophic gastritis in the antrum. Conclusions: The long-term prognosis of gastric MALT lymphoma appears indolent and is indicated by the 5-year OS and continuous remission rates. Aggressive disease courses are associated with old age, sex (male), and clinical stage II or higher, but are not related to OS.

Keywords

References

  1. Stolte M, Bayerdorffer E, Morgner A, Alpen B, Wundisch T, Thiede C, et al. Helicobacter and gastric MALT lymphoma. Gut 2002;50 Suppl 3:III19-III24.
  2. Thiede C, Morgner A, Alpen B, Wundisch T, Herrmann J, Ritter M, et al. What role does Helicobacter pylori eradication play in gastric MALT and gastric MALT lymphoma? Gastroenterology 1997;113:S61-S64.
  3. Kim JS, Park JC, Lee JY, Ahn JY, Kang SH, Yang HJ, et al. Long-term clinical outcomes of gastric MALT lymphoma: a nationwide multicenter study in Korea. Front Oncol 2021;11:681689.
  4. Nakamura S, Sugiyama T, Matsumoto T, Iijima K, Ono S, Tajika M, et al. Long-term clinical outcome of gastric MALT lymphoma after eradication of Helicobacter pylori: a multicentre cohort follow-up study of 420 patients in Japan. Gut 2012;61:507-513.
  5. Wundisch T, Thiede C, Morgner A, Dempfle A, Gunther A, Liu H, et al. Long-term follow-up of gastric MALT lymphoma after Helicobacter pylori eradication. J Clin Oncol 2005;23:8018-8024.
  6. Zucca E, Arcaini L, Buske C, Johnson PW, Ponzoni M, Raderer M, et al. Marginal zone lymphomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2020;31:17-29.
  7. Fischbach W. Gastric MALT lymphoma - update on diagnosis and treatment. Best Pract Res Clin Gastroenterol 2014;28:1069-1077.
  8. Copie-Bergman C, Wotherspoon AC, Capella C, Motta T, Pedrinis E, Pileri SA, et al. Gela histological scoring system for post-treatment biopsies of patients with gastric MALT lymphoma is feasible and reliable in routine practice. Br J Haematol 2013;160:47-52.
  9. Lee SK, Lee YC, Chung JB, Chon CY, Moon YM, Kang JK, et al. Low grade gastric mucosa associated lymphoid tissue lymphoma: treatment strategies based on 10 year follow-up. World J Gastroenterol 2004;10:223-226.
  10. Gong EJ, Ahn JY, Jung HY, Park H, Ko YB, Na HK, et al. Helicobacter pylori eradication therapy is effective as the initial treatment for patients with H. pylori-negative and disseminated gastric mucosa-associated lymphoid tissue lymphoma. Gut Liver 2016;10:706-713.
  11. Kim JS, Chung SJ, Choi YS, Cheon JH, Kim CW, Kim SG, et al. Helicobacter pylori eradication for low-grade gastric mucosa-associated lymphoid tissue lymphoma is more successful in inducing remission in distal compared to proximal disease. Br J Cancer 2007;96:1324-1328.
  12. Hong SS, Jung HY, Choi KD, Song HJ, Lee GH, Oh TH, et al. A prospective analysis of low-grade gastric malt lymphoma after Helicobacter pylori eradication. Helicobacter 2006;11:569-573.
  13. Asano N, Iijima K, Koike T, Imatani A, Shimosegawa T. Helicobacter pylori-negative gastric mucosaassociated lymphoid tissue lymphomas: a review. World J Gastroenterol 2015;21:8014-8020.
  14. Stathis A, Chini C, Bertoni F, Proserpio I, Capella C, Mazzucchelli L, 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. Ann Oncol 2009;20:1086-1093.
  15. Ruskone-Fourmestraux A, Lavergne A, Aegerter PH, Megraud F, Palazzo L, de Mascarel A, et al. Predictive factors for regression of gastric MALT lymphoma after anti-Helicobacter pylori treatment. Gut 2001;48:297-303.
  16. Park JY, Kim SG, Kim JS, Jung HC. Bone marrow involvement is rare in superficial gastric mucosaassociated lymphoid tissue lymphoma. Dig Liver Dis 2016;48:81-86.
  17. Cohen SM, Petryk M, Varma M, Kozuch PS, Ames ED, Grossbard ML. Non-Hodgkin's lymphoma of mucosa-associated lymphoid tissue. Oncologist 2006;11:1100-1117.
  18. Zullo A, Hassan C, Cristofari F, Andriani A, De Francesco V, Ierardi E, et al. Effects of Helicobacter pylori eradication on early stage gastric mucosa-associated lymphoid tissue lymphoma. Clin Gastroenterol Hepatol 2010;8:105-110.
  19. Rentien AL, Levy M, Copie-Bergman C, Gagniere C, Dupuis J, Le Baleur Y, et al. Long-term course of precancerous lesions arising in patients with gastric MALT lymphoma. Dig Liver Dis 2018;50:181-188.
  20. Capelle LG, den Hoed CM, de Vries AC, Biermann K, Casparie MK, Meijer GA, et al. Premalignant gastric lesions in patients with gastric mucosa-associated lymphoid tissue lymphoma and metachronous gastric adenocarcinoma: a case-control study. Eur J Gastroenterol Hepatol 2012;24:42-47.
  21. Smet A, Menard A. Review: other Helicobacter species. Helicobacter 2020;25 Suppl 1:e12744.
  22. Takigawa H, Masaki S, Naito T, Yuge R, Urabe Y, Tanaka S, et al. Helicobacter suis infection is associated with nodular gastritis-like appearance of gastric mucosa-associated lymphoid tissue lymphoma. Cancer Med 2019;8:4370-4379.
  23. Murga Penas EM, Hinz K, Roser K, Copie-Bergman C, Wlodarska I, Marynen P, et al. Translocations t(11;18)(q21;q21) and t(14;18)(q32;q21) are the main chromosomal abnormalities involving MLT/MALT1 in MALT lymphomas. Leukemia 2003;17:2225-2229.
  24. Liu H, Ye H, Ruskone-Fourmestraux A, De Jong D, Pileri S, Thiede C, et al. T(11;18) is a marker for all stage gastric MALT lymphomas that will not respond to H. pylori eradication. Gastroenterology 2002;122:1286-1294.
  25. Toyoda K, Maeshima AM, Nomoto J, Suzuki T, Yuda S, Yamauchi N, et al. Mucosa-associated lymphoid tissue lymphoma with t(11;18)(q21;q21) translocation: long-term follow-up results. Ann Hematol 2019;98:1675-1687.