結膜MALTリンパ腫における治療方針の検討

Therapeutic strategy for malignant MALT lymphoma of conjunctiva

要約　目的：結膜に限局したMALTリンパ腫の臨床経過の報告。対象と方法：2011年までの24年間に受診した結膜リンパ腫患者のうち，結膜に限局し，生検でMALTリンパ腫と診断され，1年以上の経過が追跡できた43例58眼を対象とした。男性が14例，女性が29例で，15例が両眼性，28例が片眼性であった。27例40眼には放射線治療を行い，16例18眼は無治療とした。結果：全43例の10年全生存率は100％，10年無再発生存率は86％で，うち放射線治療群では96％，無放射線治療群では67％であった。再発は治療群に1例，無治療群に2例あった。有害事象としての白内障とドライアイは，いずれも治療群で有意に多かった（p＝0.003，p＝0.036）。結論：結膜に原発するMALTリンパ腫は，放射線治療を行わなくても経過がかなり良好であり，放射線治療後に局所再発があり，これに関連する有害事象が生じる。結膜に原発するMALTリンパ腫の治療方針は，これらを考慮したうえで決める必要がある。

Abstract.　Purpose：To report the clinica1 outcome of mucosa-associated lymphoid tissue（MALT）lymphoma of conjunctiva. Cases and Method：This retrospective study was made on 58 eyes of 43 patients who were seen during 24 years through 2011, who showed lymphoma localized in the conjunctiva, who were diagnosed with MALT lymphoma by biopsy, and who were followed up for one year or longer. The series comprised 14 males and 29 females. MALT lymphoma was unilateral in 28 cases and bilateral in 15 cases. Radiotherapy was performed on 40 eyes of 27 cases and not on 18 eyes of 16 cases. Results：Ten-year rate of survival was 100％ in the series. Ten-year survival without recurrence was 86％ in the whole series, comprising 96％ in the group treated by radiation and 67％ in the non-treated group. MALT lymphoma recurred in one case in the treated and in 2 cases in non-treated group. Cataract and dry eye were more frequent in the treated than non-treated group（p＝0.003，p＝0.036 respectively）. Conclusion：Clinical outcome was fairly good in cases of MALT lymphoma not treated by radiation. Cases treated by radiation showed occasional recurrences and adverse events. Due consideration is needed in deciding the therapeutic strategy for malignant MALT lymphoma of conjunctiva.