胃MALTリンパ腫の治療法選択と予後

Treatment of Gastric MALT Lymphoma

要旨　近年増加傾向がみられる胃悪性リンパ腫の中で，MALTリンパ腫について議論される機会が多くなっている．過去28年間に経験した胃悪性リンパ腫111例のうちMALTリンパ腫は33例（29.7％）であった．この33例を検討した結果，胃の全体を占める症例が21例（63.6％），腫瘍最大径の中央値は17cm，深達度はsm26例（78.8％），mp5例，ss2例，リンパ節転移はn₁(＋)21.2％，n₂(＋)18.2％，計39.4％，D₂以上のリンパ節郭清は31例（93.9％），全摘が25例（75.8％）であった．1例が再発死亡したが5年生存率は85.4％であった．MALTリンパ腫は腫瘍径が大きくリンパ節転移率が高いが，適切な手術によって良好な治療成績を得ることができた．

　Gastric malignant lymphoma has became more prevalent lately, and MALT lymphoma in particular has been the subject of considerable discussion. There have been 33 (29.7%)cases of MALT lymphoma among the 111 gastric malignant lymphoma cases we have encountered over the past 28 years. Investigation of these 33 cases has revealed the following: 21 cases (63.6%) involved the whole stomach; mean tumor diameter of the 33 cases was 17 cm; depth of invasion was submucosa in 26 cases, muscularis propria in five cases, and subserosa in two cases; nodal metastasis was observed in 39.4% of the cases〔n₁ (+) in 21.2%, n₂ (+) in 18.2%〕. Over D₂ lymph node dissection was performed in 31 cases (93.9%) and total gastrectomy in 25 cases (75.8%). One case died from recurrence, but the overall 5-year survival rate was 85.4%. The MALT lymphoma in general were large in diameter and the incidence of nodal metastasis was high, yet favorable results were obtained by appropriate surgery.