title: Helicobacter pylori-related diffuse large B-cell lymphoma of the stomach: a distinct entity with lower aggressiveness and higher chemosensitivity.
abstract: We recently showed that Helicobacter pylori (HP)-positive gastric 'pure' diffuse large B-cell lymphoma (DLBCL) may respond to HP eradication therapy. However, whether these HP-related 'pure' DLBCL of the stomach may differ fundamentally from those unrelated to HP remains unclear. In this study, we compared the clinicopathologic features of these two groups of patients who had been uniformly treated by conventional chemotherapy. Forty-six patients were designated HP-positive and 49 were HP-negative by conventional criteria. HP-positive patients had a lower International Prognostic Index score (0-1, 65% vs 43%, P=0.029), a lower clinical stage (I-IIE1, 70% vs 39%, P=0.003), a better tumor response to chemotherapy (complete pathologic response, 76% vs 47%, P=0.004) and significantly superior 5-year event-free survival (EFS) (71.7% vs 31.8%, P<0.001) and overall survival (OS) (76.1% vs 39.8%, P<0.001). To draw a closer biologic link with HP, HP-positive tumors were further examined for CagA expression in lymphoma cells. Compared with CagA-negative cases (n=16), CagA-positive cases (n=27) were associated with high phosphorylated SHP-2 expression (P=0.016), and even better 5-year EFS (85.2% vs 46.3%, P=0.002) and OS (88.9% vs 52.9%, P=0.003). HP-related gastric 'pure' DLBCL may be a distinct tumor entity, which is less aggressive, and responds better to conventional chemotherapy.
authors.affiliation: 1] Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan [2] Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan [3] Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan [4] Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: S-H
authors.initials: SH
authors.lastname: Kuo
authors.affiliation: 1] Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan [2] Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan [3] Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: K-H
authors.initials: KH
authors.lastname: Yeh
authors.affiliation: 1] Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan [2] Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan [3] Department of Internal Medicine, National Cheng-Kung University Hospital, Tainan, Taiwan.
authors.forename: L-T
authors.initials: LT
authors.lastname: Chen
authors.affiliation: Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: C-W
authors.initials: CW
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: P-N
authors.initials: PN
authors.lastname: Hsu
authors.affiliation: 1] Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan [2] Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan [3] Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: C
authors.initials: C
authors.lastname: Hsu
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: M-S
authors.initials: MS
authors.lastname: Wu
authors.affiliation: 1] Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan [2] Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Y-S
authors.initials: YS
authors.lastname: Tzeng
authors.affiliation: 1] Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan [2] Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: H-J
authors.initials: HJ
authors.lastname: Tsai
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: H-P
authors.initials: HP
authors.lastname: Wang
authors.affiliation: 1] Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan [2] Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan [3] Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan [4] Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan [5] Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan.
authors.forename: A-L
authors.initials: AL
authors.lastname: Cheng
mesh_terms: D000942:Antigens, Bacterial / Q000096:biosynthesis; D001426:Bacterial Proteins / Q000096:biosynthesis; D018572:Disease-Free Survival; D005260:Female; D016481:Helicobacter Infections / Q000378:metabolism / Q000382:microbiology / Q000503:physiopathology*; D016480:Helicobacter pylori / Q000302:isolation & purification* / Q000378:metabolism; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology* / Q000473:pathology
chemical_list: D000942:Antigens, Bacterial; D001426:Bacterial Proteins; C080866:cagA protein, Helicobacter pylori