胃と腸42巻8号

2007年07月発行

今月の主題 胃MALTリンパ腫―除菌無効例の特徴と治療戦略

主題

除菌に反応しない胃MALTリンパ腫の臨床および分子病理学的特徴―長期予後を含め

著者： 中村昌太郎¹² 松本主之¹ 古賀秀樹¹ 江崎幹宏¹ 矢田親一朗¹ 城由起彦¹ 八尾隆史³ 飯田三雄¹

所属機関： ¹九州大学大学院病態機能内科学 ^{2 3}九州大学大学院形態機能病理学

ページ範囲：P.1225 - P.1240

文献概要

要旨　Helicobacter pylori除菌治療を行った胃MALTリンパ腫100例〔diffuse large B-cell lymphoma（DLBCL）併存18例を含む〕を対象とし，除菌抵抗例の臨床および分子病理学的特徴を解析した．除菌奏効（完全寛解またはprobable minimal residual disease）率は67％であり，DLBCL非併存例（71％）と併存例（50％）で差はなかった．t(11;18)/API2-MALT1はDLBCL非併存例の14％に認め，トリソミー18を示唆するMALT1過剰コピーは32％にみられた．非奏効群は奏効群に比べ，高齢で，男性，胃上部局在，非表層型，粘膜下層深部浸潤，進行病期，H. pylori陰性，Bcl10核内発現およびt(11;18)/API2-MALT1の頻度が高かった．多変量解析の結果，有意な除菌抵抗因子は粘膜下層深部浸潤と胃上部局在のみであった．奏効群67例のうち6例（9％）で経過中に一時的に組織学的再燃を認めた．非奏効群のうち30例に二次治療（経口単剤化学療法12例，放射線療法9例，多剤併用化学療法5例，胃切除4例）を行い，26例（87％）で完全寛解が得られた．5年後のoverall survivalおよびevent-free survival（EFS）は90％および77％であり，多変量解析ではMALT1過剰コピーが独立したEFS規定因子であった．今後，非奏効群に対しては，遺伝子学的所見も考慮したオーダーメイド治療が望まれる．

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