胃と腸41巻3号

2006年03月発行

今月の主題 腸管悪性リンパ腫―最近の知見 主題

腸管原発悪性リンパ腫の治療と予後―113例の遡及的解析

著者： 中村昌太郎¹ 松本主之¹ 中村滋郎¹ 末兼浩史² 竹下盛重³ 江崎幹宏¹ 矢田親一朗¹ 城由起彦¹ 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福岡大学医学部病理学 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.323 - P.337

要旨　腸管原発悪性リンパ腫113例（MALTリンパ腫33例，濾胞性リンパ腫9例，マントル細胞リンパ腫2例，びまん性大細胞型B細胞性リンパ腫46例，Burkittリンパ腫7例，リンパ芽球性リンパ腫3例，T細胞性リンパ腫13例）を対象として治療法と予後の関連を遡及的に解析した．非外科的治療群（除菌，放射線または化学療法；n＝23）と外科的切除群（n＝90）ではoverall survival（OS），event-free survival（EFS）ともに差はみられなかった．多変量解析の結果，T/B免疫表現型と臨床病期のみがOSおよびEFSの独立した予後規定因子であった．複数腸管浸潤はEFSのみの予後因子であった．現時点では，外科的切除と化学療法の併用が限局した腸管悪性リンパ腫の標準的治療であるが，今後，非外科的治療の適応について，前向き研究による評価が必要と考えられる．

参考文献

1) Freeman C, Berg JW, Cutler SJ. Occurrence and prognosis of extranodal lymphomas. Cancer 29 : 252-260, 1972

2) Isaacson PG, Norton AJ. Extranodal Lymphomas. Churchill Livingstone, Edinburgh, pp 1-65, 1994

3) Nakamura S, Matsumoto T, Iida M, et al. Primary gastrointestinal lymphoma in Japan : A clinicopathologic analysis of 455 patients with special reference to its time trends. Cancer 97 : 2462-2473, 2003

4) Koch P, del Valle F, Berdel WE, et al. Primary gastrointestinal non-Hodgkin's lymphoma : II. Combined surgical and conservative or conservative management only in localized gastric lymphoma―Results of the prospective German Multicenter Study GIT NHL 01/92. J Clin Oncol 19 : 3874-3883, 2001

5) Nakamura S, Matsumoto T, Suekane S, et al. Predictive value of endoscopic ultrasonography for regression of gastric low grade and high grade MALT lymphomas after eradication of Helicobacter pylori. Gut 48 : 454-460, 2001

6) Nakamura S, Matsumoto T, Sukane H, et al. Long-term clinical outcome of Helicobacter pylori eradication for gastric mucosa-associated lymphoid tissue lymphoma with a reference to second-line treatment. Cancer 104 : 532-540, 2005

7) Nakamura S, Matsumoto T, Takeshita M, et al. A clinicopathologic study of primary small intestine lymphoma : Prognostic significance of mucosa-associated lymphoid tissue-derived lymphoma. Cancer 88 : 286-294, 2000

8) 中村昌太郎，松本主之，八尾隆史，他．悪性リンパ腫，IPSID．八尾恒良，飯田三雄(編)．小腸疾患の臨床．医学書院，pp340-351, 2004

9) Jaffe ES, Harris NL, Stein H, et al(eds). World Health Organization classification of tumours : Pathology and genetics of tumours of haematopoietic and lymphoid tissues. IARC, Lyon, 2001

10) Matsumoto T, Iida M, Shimizu M. Regression of mucosa-associated lymphoid tissue lymphoma of the rectum after eradication of Helicobacter pylori. Lancet 350 : 115-116, 1997

11) Matsumoto T, Shimizu M, Iida M, et al. Primary low-grade, B-cell, mucosa-associated lymphoid tissue lymphoma of the colorectum : Clinical and colonoscopic features in six cases. Gastrointest Endosc 48 : 501-508, 1998

12) Nakamura S, Matsumoto T, Nakamura S, et al. t(11 ; 18)(q21 ; q21)-associated low-grade mucosa-associated lymphoid tissue lymphoma involving the gastrointestinal tract, the lungs, and the salivary glands. J Gastroenterol 39 : 1220-1222, 2004

13) Radaszkiewicz T, Dragosics B, Bauer P. Gastrointestinal malignant lymphomas of the mucosa-associated lymphoid tissue : Factors relevant to prognosis. Gastroenterology 102 : 1628-1638, 1992

14) Domizio P, Owen RA, Shepherd NA, et al. Primary lymphoma of the small intestine : A clinicopathologic study of 119 cases. Am J Surg Pathol 17 : 429-442, 1993

k K, et al. Non-Hodgkin's lymphoma of the gastrointestinal tract : A population-based analysis of incidence, geographic distribution, clinicopathologic presentation features, and prognosis. J Clin Oncol 12 : 1673-1684, 1994

16) Kodama T, Ohshima, K, Nomura K, et al. Lymphomatous polyposis of the gastrointestinal tract, including mantle cell lymphoma, follicular lymphoma and mucosa-associated lymphoid tissue lymphoma. Histopathology 47 : 467-478, 2005

17) Gale J, Simmonds PD, Mead GM, et al. Enteropathy-type intestinal T-cell lymphoma : Clinical features and treatment of 31 patients in a single center. J Clin Oncol 18 : 795-803, 2000

18) Daum S, Ullrich R, Heise W, et al. Intestinal non-Hodgkin's lymphoma : A multicenter prospective clinical study from the German study group on intestinal non-Hodgkin's lymphoma. J Clin Oncol 21 : 2740-2746, 2003

19) Green PHR, Jabri B. Coeliac disease. Lancet 362 : 383-391, 2003

20) Ruskoné-Fourmestraux A, Aegerter P, Delmer A, et al. Primary digestive tract lymphoma : A prospective multicentric study of 91 patients. Gastroenterology 105 : 1662-1671, 1993

21) Salles G, Herbrecht R, Tilly H, et al. Aggressive primary gastrointestinal lymphomas : Review of 91 patients treated with the LNH-84 regimens. A study of the Groupe d'Etude des Lymphomes Agressifs. Am J Med 90 : 77-84, 1991

22) Liang R, Todd D, Chan TK, et al. Prognostic factors for primary gastrointestinal lymphoma. Hematol Oncol 13 : 153-163, 1995

23) Cho MJ, Ha CS, Allen PK, et al. Primary non-Hodgkin lymphoma of the large bowel. Radiology 205 : 535-539, 1997

24) Ha CS, Cho MJ, Allen PK, et al. Primary non-Hodgkin lymphoma of the small bowel. Radiology 211 : 183-187, 1999

25) Nagashima R, Takeda H, Maeda K, et al. Regression of duodenal mucosa-associated lymphoid tissue lymphoma after eradication of Helicobacter pylori. Gastroenterology 111 : 1674-1678, 1996