Long-term follow-up of gastrectomized patients with mucosa-associated lymphoid tissue lymphoma: need for a revisit of surgical treatment.
BACKGROUND
Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is characterized by multifocality of the tumors, which often scatter over the mucosa of the stomach and adjacent upper gastrointestinal tract, and is therefore theoretically not curable by surgical resection.


METHODS
We conducted a long-term follow-up study of 14 patients who received surgical treatment for gastric MALT lymphoma. Tissues from the surgical margins of the resected stomach were analyzed by polymerase chain reaction-based amplification of the complementarity-determining region 3 of the IgH gene for the presence of residual tumors. T (11;18)(q21;q21), a marker of Helicobacter pylori-independent MALT lymphoma, was analyzed by reverse transcription polymerase chain reaction. All living patients were restaged, and rebiopsied if suspicious lesions were identified.


RESULTS
At a median follow-up of 11.5 years, only 1 patient had evidence of tumor recurrence. Three patients with molecularly proven residual tumors in the surgical margin remained disease-free at 9.6 to 11.6 years. Five patients with t(11;18)(q21;q21) in the tumor cells were disease-free at 9.2 to 12.6 years.


CONCLUSIONS
Our results indicate that surgical resection is a highly curative treatment for gastric MALT lymphoma, even for patients with residual tumor cells in the surgical margins, and for patients with H. pylori-independent tumors. A revisit of surgical treatment for gastric MALT lymphoma is mandatory.
Kuo
Sung-Hsin
SH
Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Chen
Li-Tzong
LT
Wu
Ming-Shiang
MS
Lin
Chung-Wu
CW
Yeh
Kun-Huei
KH
Kuo
Kuan-Ting
KT
Yeh
Pei-Yen
PY
Tzeng
Yi-Shin
YS
Wang
Hsiu-Po
HP
Hsu
Ping-Ning
PN
Lin
Jaw-Town
JT
Cheng
Ann-Lii
AL
D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000235:genetics / Q000378:metabolism; D001706:Biopsy; D022801:Complementarity Determining Regions / Q000235:genetics; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D018442:Lymphoma, B-Cell, Marginal Zone / Q000175:diagnosis / Q000235:genetics / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015514:Oncogene Proteins, Fusion / Q000235:genetics; D011379:Prognosis; D012334:RNA, Neoplasm / Q000235:genetics; D012086:Reoperation; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000601:surgery*; D013997:Time Factors
C415943:API2-MALT1 fusion protein, human; D014408:Biomarkers, Tumor; D022801:Complementarity Determining Regions; D007143:Immunoglobulin Heavy Chains; D015514:Oncogene Proteins, Fusion; D012334:RNA, Neoplasm