腸管原発悪性リンパ腫の治療と予後―113例の遡及的解析

Treatment and Prognosis of Primary Intestinal Lymphoma―A Retrospective Analysis of 113 Patients

要旨　腸管原発悪性リンパ腫113例（MALTリンパ腫33例，濾胞性リンパ腫9例，マントル細胞リンパ腫2例，びまん性大細胞型B細胞性リンパ腫46例，Burkittリンパ腫7例，リンパ芽球性リンパ腫3例，T細胞性リンパ腫13例）を対象として治療法と予後の関連を遡及的に解析した．非外科的治療群（除菌，放射線または化学療法；n＝23）と外科的切除群（n＝90）ではoverall survival（OS），event-free survival（EFS）ともに差はみられなかった．多変量解析の結果，T/B免疫表現型と臨床病期のみがOSおよびEFSの独立した予後規定因子であった．複数腸管浸潤はEFSのみの予後因子であった．現時点では，外科的切除と化学療法の併用が限局した腸管悪性リンパ腫の標準的治療であるが，今後，非外科的治療の適応について，前向き研究による評価が必要と考えられる．

　To investigate the influence of therapeutic modalities on the prognosis of patients with primary intestinal lymphoma, we retrospectively analyzed 113 patients, comprised of 33 with MALT lymphoma, 9 with follicular lymphoma, 2 with mantle cell lymphoma, 46 with diffuse large B-cell lymphoma, 7 with Burkitt lymphoma, 3 with lymphoblastic lymphoma, and 13 with T-cell lymphoma. Neither overall survival (OS) nor event-free survival (EFS) differed between patients who underwent non-surgical treatment (eradication, chemotherapy or radiotherapy ; n＝23) and those treated by surgery (n＝90). Cox multivariate analysis revealed that T or B cell phenotype and clinical stage were independent prognostic factors for both OS and EFS. Multiple involvement of the intestine was also an independent prognostic factor for EFS, but not for OS. At present, a combination of surgical resection and chemotherapy seems to be the standard therapeutic modality for intestinal lymphoma. However, prospective studies with a large number of patients are still needed to evaluate the efficacy of non-surgical treatment for this disease.