Long-term clinical outcome of gastric MALT lymphoma after eradication of Helicobacter pylori: a multicentre cohort follow-up study of 420 patients in Japan
- Shotaro Nakamura1,
- Toshiro Sugiyama2,
- Takayuki Matsumoto1,
- Katsunori Iijima3,
- Shouko Ono4,
- Masahiro Tajika5,
- Akira Tari6,
- Yasuhiko Kitadai7,
- Hiroshi Matsumoto8,
- Tadanobu Nagaya9,
- Toshiro Kamoshida10,
- Norihiko Watanabe11,
- Toshimi Chiba12,
- Hideki Origasa13,
- Masahiro Asaka14,
- for the JAPAN GAST Study Group
- 1Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- 2Department of Gastroenterology and Hematology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
- 3Department of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
- 4Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
- 5Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan
- 6Division of Gastroenterology, Department of Internal Medicine, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, Hiroshima, Japan
- 7Department of Medicine and Molecular Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
- 8Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Kurashiki, Japan
- 9Division of Gastroenterology, Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
- 10Division of Gastroenterology, Department of Internal Medicine, Hitachi General Hospital, Hitachi, Japan
- 11Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- 12Department of Gastroenterology and Hepatology, School of Medicine Iwate Medical University, Morioka, Japan
- 13Department of Biostatistics and Clinical Epidemiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
- 14Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- Correspondence to Dr Shotaro Nakamura, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan;
Contributors SN, TC and TS conceived and designed this study with the JAPANGAST Study Group. SN, KI, SO, MT, AT, YK, HM, TN, TK, NW, TC and TM collected the data of patients. SN and HO analysed and interpreted the results. SN and TM drafted the manuscript. MA and TS were responsible for the overall planning and conduct of the study and critically reviewed the manuscript. All authors have read and approved the final version of the manuscript.
- Revised 10 July 2011
- Accepted 29 July 2011
- Published Online First 2 September 2011
Objective A multicentre cohort follow-up study of a large number of patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma was conducted to elucidate the long-term outcome of the disease after Helicobacter pylori eradication.
Methods 420 patients with gastric low-grade MALT lymphoma who had undergone successful H pylori eradication and been followed up for at least 3 years were registered from 21 participating institutes. Responders to treatment were defined as patients whose post-treatment biopsies showed complete histological response (ChR) or probable minimal residual disease (pMRD). Treatment failure was defined as the status of progressive disease or lymphoma relapse after ChR/pMRD.
Results 323 patients (77%) responded to H pylori eradication. A logistic regression analysis showed that absence of H pylori, submucosal invasion determined by endoscopic ultrasonography and t(11;18)/API2-MALT1 were independent predictors of resistance to H pylori eradication. During the follow-up periods ranging from 3.0 to 14.6 years (mean 6.5 years, median 6.04 years), the disease relapsed in 10 of 323 responders (3.1%) while progressive disease was found in 27 of 97 non-responders (27%). Thus, 37 of 420 patients (8.8%) were regarded as treatment failures. Of these 37 patients, transformation into diffuse large B cell lymphoma occurred in nine patients. Among the non-responders and relapsed patients, 17 patients were subjected to a ‘watch and wait’ strategy while 90 patients underwent second-line treatments including radiotherapy (n=49), chemotherapy (n=26), surgical resection (n=6), chemoradiotherapy (n=5), antibiotic treatment (n=2), rituximab monotherapy (n=1) or endoscopic resection (n=1). Probabilities of freedom from treatment failure, overall survival and event-free survival after 10 years were 90%, 95% and 86%, respectively. Cox multivariate analysis revealed endoscopic non-superficial type to be an independent prognostic factor for adverse freedom from treatment failure, overall survival and event-free survival.
Conclusions The excellent long-term outcome of gastric MALT lymphoma after H pylori eradication was confirmed by this large-scale follow-up study.
- Gastric lymphoma
- Helicobacter pylori
- endoscopic ultrasonography
- gastric cancer
- gastric and duodenal ulcers
- Helicobacter pylori - treatment
- Helicobacter pylori - pathogenesis
- colorectal neoplasm
- colonic polyps
- colorectal carcinoma
- endoscopic polypectomy
- autoimmune hepatitis
- liver immunology
- gastrointestinal immune response
- immunology in hepatology
Funding This study was supported by Grants-in-aid from the Ministry of Education, Culture, Sports, Sciences, and Technology of Japan No. 20590744 (SN, TM).
Competing interests None.
Patient consent Obtained.
Ethics approval The ethics committee at Kyushu University Hospital.
Provenance and peer review Not commissioned; externally peer reviewed.