胃と腸39巻3号

2004年03月発行

今月の主題 胃MALTリンパ腫―除菌治療後の経過と予後 主題

胃原発B細胞性リンパ腫の治療と予後―MALTリンパ腫の治療戦略を中心に

著者： 中村昌太郎¹ 松本主之¹ 中村滋郎¹ 江崎幹宏¹ 末兼浩史² 矢田親一朗¹ 松本啓志³ 八尾隆史⁴ 飯田三雄¹

所属機関： ¹九州大学大学院医学研究院病態機能内科学 ²山口赤十字病院内科 ³川崎医科大学内科学食道・胃腸科 ⁴九州大学大学院医学研究院形態機能病理学

ページ範囲：P.261 - P.275

要旨　胃原発B細胞性リンパ腫322例（低悪性度MALTリンパ腫186例，diffuse large B-cell lymphoma（DLBL）82例，DLBL併存MALTリンパ腫54例）を対象として治療法と予後の関連を遡及的に解析し，このうちH.pylori除菌を行った96例については長期経過および除菌無効例に対する二次治療の効果を検討した．胃温存治療群（除菌，放射線または化学療法;n＝100）は外科切除群（n＝222）より高い全生存率を示したが，非増悪率に差はなく，多変量解析では，治療法の違いは予後に影響しなかった．除菌により55例（57％）で完全寛解が得られ，経過中に4例（7％）で一時的に組織学的再燃を認めた．除菌無効例のうち34例に二次治療（cyclophosphamide経口単剤化学療法11例，放射線療法9例，CHOP化学療法10例，胃切除4例）を行い，29例（85％）で完全寛解に導入できた．これらの結果より，胃B細胞性リンパ腫の治療には胃温存治療が望ましく，除菌無効例に対しては組織型と病期に応じて，化学療法または放射線療法を追加することにより良好な予後が期待できると考えられた．

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