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Vol. 43. Issue 2.
Pages 79-86 (February 2020)
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Vol. 43. Issue 2.
Pages 79-86 (February 2020)
Original Article
DOI: 10.1016/j.gastre.2019.08.008
Heterogeneity of clinical management of low-grade gastric lymphoma of mucosa-associated lymphoid tissue. An audit of 198 patients in Spain
Heterogeneidad en el tratamiento clínico del linfoma gástrico de tejido linfoide asociado a mucosas de bajo grado. Una auditoría de 198 pacientes en España
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Ignasi Puiga,b, Erwin Sanabriac, Faust Feuc,d, Ignacio Coutoe, Marta Blancoe, Pedro Alonsoe, Javier P. Gisbertd,f, Adrian G. McNicholld,f, Agustín Seoaneg, Felipe Boryg, Francisco Poloh, Víctor Orivéh, Julio Poncei, Fernando Bordaj, Antonio Hervásk, Ángeles Pérez-Aisal, Robin Riveral, Enrique Quinterod,m,n, David Nicolás-Pérezm, Luis Bujandad,n, Luis Rodrigoo, Xavier Calvetd,p,q,
Corresponding author
XCalvet@tauli.cat

Corresponding author.
, for the Spanish Gastroenterological Association Gastroduodenal Diseases Study Group
a Digestive Diseases Department, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
b Universitat Internacional de Catalunya, Barcelona, Spain
c Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
d Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
e Digestive Diseases Department, Complexo Hospitalario Universitario A Coruña, La Coruña, Spain
f Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
g Digestive Diseases Department, Hospital del Mar, Barcelona, Spain
h Digestive Diseases Department, Hospital Basurto, Bilbao, Spain
i Digestive Diseases Department, Hospital Universitari i Politècnic la Fe, Valencia, Spain
j Digestive Diseases Department, Complejo Hospitalario de Navarra, Pamplona, Spain
k Digestive Diseases Department, Hospital Universitario Reina Sofía, Córdoba, Spain
l Digestive Diseases Department, Agencia Sanitaria Costa del Sol, Marbella, Spain
m Digestive Diseases Department, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, Spain
n Gastroenterology Department, Hospital Universitario Donostia/Biodonostia Institute, University of the Basque Country (UPV/EHU), San Sebastián, Spain
o Digestive Diseases Department, Hospital Universitario Central de Asturias, Oviedo, Spain
p Digestive Diseases Department, Corporación Sanitaria Parc Taulí, Sabadell, Spain
q Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Spain
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Figures (2)
Tables (4)
Table 1. Clinical characteristics of the patients and main finding in tests.
Table 2. H. pylori status and tests results.
Table 3. Additional treatments used according to the Ann Arbor staging in the different 13 hospitals participating in the study.
Table 4. Different frequencies of the use of aggressive treatment chemotherapy, radiotherapy or surgery) in E1 Ann Arbor lesions according to each center.
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Additional material (1)
Abstract
Introduction

Cure of Helicobacter pylori infection in patients with gastric lymphoma of mucosa-associated lymphoid tissue (MALT) leads to long-term clinical remission in the initial stages. As it is a rare disease, its management in clinical practice remains largely unknown and heterogeneity of care remains a concern.

The aim was to audit the management and evolution of a large series of low-grade gastric MALT lymphomas from thirteen Spanish hospitals.

Materials and methods

Multicentre retrospective study including data on the diagnosis and follow-up of patients with gastric low-grade MALT lymphoma from January 1998 to December 2013. Clinical, biological and pathological data were analyzed and survival curves were drawn.

Results

One-hundred and ninety-eight patients were included. Helicobacter pylori was present in 132 (69%) patients and 103 (82%) in tumors confined to the stomach (stage EI) and was eradicated in 92% of patients. Chemotherapy was given in 90 (45%) patients and 43 (33%) with stage EI. Marked heterogeneity in the use of diagnostic methods and chemotherapy was observed. Five-year overall survival was 86% (89% in EI). Survival was similar in EI patients receiving aggressive treatment and in those receiving only antibiotics (p=0.577).

Discussion

Gastric MALT lymphoma has an excellent prognosis. We observed, however, a marked heterogeneity in the use of diagnostic methods or chemotherapy in early-stage patients.

Keywords:
Lymphoma
Stomach neoplasms
Disease management
Follow-up studies
Mortality
Resumen
Introducción

La cura de la infección por Helicobacter pylori (H. pylori) en pacientes con linfoma gástrico de tejido linfoide asociado mucosas (mucosa-associated lymphoid tissue [MALT]) conduce a la remisión clínica a largo plazo en los estadios iniciales. Al tratarse de una enfermedad rara, su tratamiento en la práctica clínica en muchas ocasiones se desconoce y la heterogeneidad de la atención sigue siendo motivo de preocupación.

El objetivo es auditar el tratamiento y la evolución de una gran serie de linfomas gástricos MALT de bajo grado procedentes de 13 hospitales españoles.

Materiales y métodos

Estudio retrospectivo y multicéntrico que incluye datos sobre el diagnóstico y el seguimiento de pacientes con linfoma MALT gástrico de bajo grado desde enero de 1998 hasta diciembre del 2013. Se analizaron los datos clínicos, biológicos y patológicos, y se trazaron las curvas de supervivencia.

Resultados

Se incluyó a 198 pacientes. El H. pylori estaba presente en 132 (69%) de los pacientes y en 103 (82%) tumores confinados al estómago (estadio EI) y se erradicó en el 92% de los pacientes. Se administró quimioterapia a 90 (45%) de los pacientes y a 43 (33%) en estadio EI. Se observó una marcada heterogeneidad en el uso de los métodos de diagnóstico y de la quimioterapia. La supervivencia global a los 5 años fue del 86% (89% en estadio EI). La supervivencia fue similar en los pacientes en estadio EI que recibieron tratamiento agresivo y en los que recibieron solo antibióticos (p=0,577).

Discusión

El linfoma MALT gástrico presenta un pronóstico excelente. Sin embargo, se observó una marcada heterogeneidad en el uso de los métodos de diagnóstico o la quimioterapia en pacientes en estadio inicial.

Palabras clave:
Linfoma
Neoplasias malignas
Tratamiento de la enfermedad
Estudios de seguimiento
Mortalidad

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