小腸・大腸MALTリンパ腫の診断と治療

Diagnosis and Treatment of Intestinal Mucosa-Associated Lymphoid Tissue Lymphoma

腸管（小腸および大腸）MALTリンパ腫の診断と治療の要点について，自験例の成績を含めて概説した．自験47例においては，罹患部位は回腸（43％），結腸（32％），十二指腸（28％）に好発し，肉眼型では隆起型（32％）と潰瘍型（26％）が多くみられた．治療法は抗菌薬治療，外科切除，化学療法，リツキシマブ免疫療法，放射線療法など多岐にわたっていた．自験例の診断5年後のoverall survivalおよびprogression-free survivalは89％および80％と予後は良好であり，肉眼型（びまん/混合型），進行病期，B徴候が両者に共通した予後不良因子であった．本症の病態解明のためには，多数例の詳細な解析が必要である．

　We reviewed recent trends in the diagnosis and management of intestinal MALT（mucosa-associated lymphoid tissue）lymphoma. In an analysis of 47 patients at our institute the most frequently involved site was the ileum（43％）, followed by the colon（32％）and the duodenum（28％）. Macroscopically, most cases were classified as either polypoid（34％）or ulcerative（26％）forms. Therapeutic strategies, included antibiotic treatment, surgical resection, chemotherapy, rituximab immunotherapy, and/or radiotherapy, and these should be determined in each patient based on the areas of involvement and the clinical stage. The prognosis is excellent with an overall survival rate after 5 years of 89％ and a progression-free survival rate of 80％. Kaplan-Meier analysis revealed that macroscopic diffuse/mixed types, advanced stage, and B-symptoms were significant prognostic factors. Further detailed studies involving a large number of patients are required to elucidate the pathogenesis and long-term behavior of intestinal MALT lymphoma.