Clinical Characteristics And Prognostic Factors Of 70 Cases Of Gastric Mucosa-associated Lymphoid Tissue Lymphoma

Background and ObjectivePrimary gastric lymphoma（PGL）is the most common extranodal lymphoma among non-Hodgkin’s lymphoma,accounting for 30%to 40%of all extranodal lymphomas.Mucosa-associated lymphoid tissue（MALT）lymphoma is one of the most common histological subtypes of PGL.It is worth mentioning that gastric MALT lymphomas（GML）,which is belonged to marginal zone B-cell tumor,characterized by low-grade malignancy and inert development.Numerous studies have suggested the occurrence and development of GML are related to Helicobacter pylori（Hp）infection.It is likely to achieve complete remission by eradicating Hp at the early stage of disease.However,due to the lack of special clinical manifestations of this type of disease,it is easy to be ignored or misdiagnosed in clinical work,thus missing the best time for diagnosis and treatment.Therefore,this paper intends to analyze the clinical characteristics and prognostic factors of the disease,in order to provide more basis for the diagnosis and treatment of the disease and prognosis stratification.MethodsCollected the clinical data of 70 patients diagnosed as gastric MALT lymphoma by the First Affiliated Hospital of Zhengzhou University from January 2011 to January 2018,including age,gender,helicobacter pylori infection status,clinical symptoms,hemoglobin,β₂-MG,LDH,endoscopic morphology,pathology and immunohistochemistry,therapeutic regimen,and outcomes.The data and information were retrospectively analyzed.SPSS21.0 software was used for statistical analysis.Enumeration data were expressed by percentages.The classified data were evaluated by chi-square test,Kaplan-meier was used for univariate analysis,and Log-rank was used for comparison between groups.COX multivariate regression analysis was performed for univariate significant factors,P<0.05 was statistically significant.Results1.Among the 70 patients who were diagnosed as GML,including 38 males and32 females,ranging from19 to 82 years old,with the median age of 54 years,and the number of patients aged between 41⁶0 years old was the most,accounting for44.3%.The positive rate of Helicobacter pylori infection was 67.1%.2.The most common clinical presentation was midsection pain,accounting for48.6%,other clinical manifestations include:poorappetite and nausea（21.4%）,hematemesis or melena（21.4%）,abdominal discomfort（17.1%）,abdominal distension（15.7%）,acid reflux and heartburn（8.6%）,combined with B symptoms（11.4%）,abdominal palpable mass could be touched in 3 patients.3.The endoscopic performance can be divided into three types according to the endoscopic tumor morphology:ulcer type,uplift type and diffuse infiltration type.Corpus and antrum were the most easily involved sites.4.At the end of treatment,42 cases（60.0%）were evaluated as CR,20 cases（28.6%）wer evaluated as PR,4 cases（5.7%）were evaluated as SD,4 cases（5.7%）were evaluated as PD,the effective remission rate was 88.6%.A total of 16 patients of early stage were treated with Hp eradication alone,the effective remission rate achieved 93.8%.5.The clinical characteristics between Ann Arbor IE/IIE stage and IIIE/IVE stage were compared,IIIE/IV patients were more likely to appear B symptoms and anemia than those who were at IE/IIE stage,and the levels ofβ₂-MG,LDH and IPI score were significantly higher at the initial diagnosis,the differences were statistically significant（P<0.05）.6.Univariate analysis showed that,β₂-MG>3.0mg/L,LDH>245U/L,Ann Arbor stage（IIIE/IV）,IPI score>2,Hp infection and B symptoms were prognostic risk factors for PFS;Age older than 60 years old,β2-MG>3.0mg/L,LDH>245U/L,Ann Arbor stage（IIIE/IV）,IPI score>2 points,B symptoms were prognostic risk factors for OS.Multivariate analysis showed that IPI score>2（P<0.001）and Hp infection（P=0.026）were independent prognostic factors of PFS.ConclusionsThe majority patients of gastric mucosa-associated lymphoid tissue lymphoma were middle-aged and senior people,the most common age group was 40 to 60 years old.This onset of the disease was insidious,and there were no typical clinical symptoms and endoscopic manifestations.The remission rate after treatment was high,In the early stage,and complete remission can be achieved by eradicating helicobacter pylori at the early stage.IPI score>2 points and Hp infection were independent prognostic factors of PFS.