Objective: To evaluate the clinical characteristics and prognostic factors of patients with primary gastro-intestinal marginal zone lymphoma (MALT).
Methods: Retrospective analysis was performed in 90 patients diagnosed with primary gastro-intestinal MALT lymphoma clinical characteristics and survival analyses.
Results: Among 90 patients, 78 cases were originated from the stomach and 12 cases with extra-gastric origin. Eighty patients were classified as low-risk (IPI score 0-2), and 10 patients high-risk (IPI score 3-5). Compared to gastric MALT patients, extra-gastric cases presented with higher IPI score (7.7% vs 33.3%, P=0.025) and higher Hp infection rate (50.0% vs 87.2%, P<0.01). Treatment options for low risk patients (IPI score 0-2) included Hp eradication, surgery, radiotherapy and chemotherapy. Chemotherapy could improve progression-free survival (PFS) in low-risk patients. For high-risk patients, those receiving chemotherapy had 100% 3-year overall survival (OS). Univariate analysis revealed that ECOG (P=0.006), Mussh-off staging (P=0.008), IPI score (P=0.000), elevated LDH (P=0.019) and chemotherapy (P=0.026) were correlated with PFS. Multivariate analysis showed that higher IPI score (IPI 3-5) (OR=8.325, 95% CI 3.171-21.853, P=0.000) and chemotherapy (OR=0.319, 95% CI 0.121-0.838, P=0.020) were independent prognostic factors for PFS. ECOG (≥ 2) was independent prognostic factor for OS (OR=5.092, 95%CI 1.005-25.788, P=0.049).
Conclusion: Primary gastro-intestinal MALT lymphoma was an indolent subtype of non-Hodgkin's lymphoma. Patients usually had low risk IPI and achieved long-term survival. Frontline therapy for low-risk patients was radiotherapy or Hp eradication, and chemotherapy for high-risk ones.
目的: 了解原发胃肠道黏膜相关淋巴组织结外边缘区B细胞淋巴瘤（MALT淋巴瘤）患者临床特征及预后情况。
方法: 回顾性分析90例原发胃肠道MALT淋巴瘤患者资料，对患者临床特征和相关预后因素进行分析。
结果: 90例患者中胃内起病者78例，非胃内起病者12例。国际预后指数（IPI）评分0~2分者80例，3~5分者10例。与胃内起病者比较，非胃内起病者多为IPI 3~5分的高危患者（7.7%对33.3%，P=0.025）、幽门螺旋杆菌（Hp）感染率显著降低（50.0%对87.2%，P<0.01）。IPI评分0~2分的低危患者可选择抗Hp治疗、手术、放疗及化疗等治疗，其中化疗可提高患者无进展生存（PFS）率。接受化疗的高危患者3年总生存（OS）率达100.0%。单因素分析结果显示，ECOG评分（P=0.006）、Musshoff分期（P=0.008）、IPI评分（P=0.000）、LDH水平（P=0.019）和是否接受化疗（P=0.026）是影响患者PFS率的相关因素。多因素分析结果显示IPI评分（3~5分）（OR=8.325，95%CI 3.171~21.853，P= 0.000）和是否接受化疗（OR=0.319，95% CI 0.121~0.838，P=0.020）是影响患者PFS率的独立预后因素，ECOG评分（≥2分）是影响患者OS率的独立预后因素（OR=5.092，95% CI1.005~25.788，P=0.049）。
结论: 原发胃肠道MALT淋巴瘤是一种低度恶性的淋巴瘤，以低危患者多见，多数患者可获得长期生存。低危患者可选择放疗或抗Hp治疗作为起始治疗方案，高危患者应选择化疗。