Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2023; 29(14): 2202-2221
Published online Apr 14, 2023. doi: 10.3748/wjg.v29.i14.2202
Effectiveness of Helicobacter pylori eradication in the treatment of early-stage gastric mucosa-associated lymphoid tissue lymphoma: An up-to-date meta-analysis
Fabian Fellipe Bueno Lemos, Caroline Tianeze de Castro, Mariana Santos Calmon, Marcel Silva Luz, Samuel Luca Rocha Pinheiro, Clara Faria Souza Mendes dos Santos, Gabriel Lima Correa Santos, Hanna Santos Marques, Henrique Affonso Delgado, Kádima Nayara Teixeira, Cláudio Lima Souza, Márcio Vasconcelos Oliveira, Fabrício Freire de Melo
Fabian Fellipe Bueno Lemos, Mariana Santos Calmon, Marcel Silva Luz, Samuel Luca Rocha Pinheiro, Clara Faria Souza Mendes dos Santos, Gabriel Lima Correa Santos, Henrique Affonso Delgado, Cláudio Lima Souza, Márcio Vasconcelos Oliveira, Fabrício Freire de Melo, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Bahia, Brazil
Caroline Tianeze de Castro, Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador 40110040, Bahia, Brazil
Hanna Santos Marques, Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45029094, Bahia, Brazil
Kádima Nayara Teixeira, Campus Toledo, Universidade Federal do Paraná, Toledo 85919899, Paraná, Brazil
Author contributions: Lemos FFB, Castro CT, Teixeira KN, Souza CL, Oliveira MV, and Freire de Melo F contributed to the conceptualization of the manuscript; Lemos FFB, Castro CT, Teixeira KN, Souza CL, Oliveira MV, and Freire de Melo F designed the study methodology; Lemos FFB, Castro CT, Calmon MS, Silva Luz M, Pinheiro SLR, Faria Souza Mendes dos Santos C, Santos GLC, Marques HS and Delgado HA were responsible for manuscript visualization; Lemos FFB, Calmon MS, Silva Luz M, Pinheiro SLR, Faria Souza Mendes dos Santos C, Santos GLC, Marques HS, Delgado HA, Teixeira KN, Souza CL, Oliveira MV, and Freire de Melo F contributed to the investigation; Lemos FFB, Calmon MS, Silva Luz M, Pinheiro SLR, Faria Souza Mendes dos Santos C, Santos GLC, Marques HS, Delgado HA performed formal analysis; Lemos FFB wrote the original draft; Castro CT and Silva Luz M were responsible for manuscript editing; Castro CT, Silva Luz M, Teixeira KN, Souza CL, and Oliveira MV were responsible for manuscript writing and review; and Freire de Melo F supervised the writing of the original draft.
Supported by the Scientific Initiation Scholarship Programme (PIBIC) of the Bahia State Research Support Foundation, FAPESB, Brazil; the Doctorate Scholarship Program of the Coordination of Improvement of Higher Education Personnel, CAPES, Brazil; the Scientific Initiation Scholarship Programme (PIBIC) of the National Council for Scientific and Technological Development, CNPq, Brazil; and the CNPq Research Productivity Fellowship (PQ).
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fabrício Freire de Melo, PhD, Professor, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Estrada do Bem Querer, 3293-3391 - Candeias, Vitória da Conquista 45029094, Bahia, Brazil. freiremeloufba@gmail.com
Received: November 19, 2022
Peer-review started: November 19, 2022
First decision: November 30, 2022
Revised: December 10, 2022
Accepted: March 14, 2023
Article in press: March 14, 2023
Published online: April 14, 2023
Abstract
BACKGROUND

Gastric mucosa-associated lymphoid tissue (MALT) lymphoma (GML) is usually a low-grade B-cell neoplasia strongly associated with Helicobacter pylori (H. pylori)-induced chronic gastritis. Clinical practice guidelines currently recommend H. pylori eradication as the preferred initial treatment for early-stage GML. To determine the practical effect of bacterial eradication as the sole initial therapy for early-stage GML, an updated analysis and review of available evidence is imperative.

AIM

To perform a meta-analysis to assess the rate of complete remission (CR) of H. pylori-positive early-stage GML following bacterial eradication.

METHODS

We performed independent, computer-assisted literature searches using the PubMed/MEDLINE, Embase, and Cochrane Central databases through September 2022. Prospective and retrospective observational studies evaluating the CR of early-stage GML following bacterial eradication in H. pylori-positive patients. The risk of bias was assessed using Joanna Briggs Institute (JBI) Critical Appraisal Tools. The pooled estimate of the complete histopathological remission rate and respective confidence intervals (95%CI) were calculated following the random-effects model. Heterogeneity and inconsistency were assessed using Cochran’s Q test and I2 statistic, and heterogeneity was defined as P < 0.01 and I² > 50%, respectively. Subgroup and meta-regression analyses were conducted to explore potential sources of heterogeneity.

RESULTS

The titles and abstracts of 1576 studies were screened; 96 articles were retrieved and selected for full-text reading. Finally, 61 studies were included in the proportional meta-analysis (P-MA). Forty-six were prospective and fifteen were retrospective uncontrolled, single-arm, observational studies. The overall risk of bias was low to moderate in all but a single report, with an average critical appraisal score across all studies of 79.02%. A total of 2936 H. pylori-positive early-stage GML patients, in whom H. pylori was successfully eradicated, were included in the analysis. The pooled CR of H. pylori-positive early-stage GML after bacterial eradication was 75.18% (95%CI: 70.45%-79.91%). P-MA indicated the substantial heterogeneity in CR reported across studies (I2 = 92%; P < 0.01). Meta-regression analysis identified statistically significant effect modifiers, including the proportion of patients with t(11;18)(q21;q21)-positive GML and the risk of bias in each study.

CONCLUSION

Comprehensive synthesis of available evidence suggests that H. pylori eradication is effective as the sole initial therapy for early-stage GML. Although the substantial heterogeneity observed across studies limits the interpretation of the pooled overall CR, the present study is a relevant to informing clinical practice.

Keywords: Lymphoma, B-cell, Marginal zone, Gastric mucosa-associated lymphoid tissue lymphoma, Stomach lymphoma, Helicobacter pylori, Therapeutics, Eradication therapy

Core Tip: Gastric mucosa-associated lymphoid tissue (MALT) lymphoma (GML) is usually a low-grade B-cell neoplasia strongly associated with Helicobacter pylori (H. pylori)-induced chronic gastritis. Clinical practice guidelines currently recommend H. pylori eradication as the preferred initial treatment for early-stage GML. Despite advances in determining the practical effect of bacterial eradication as sole initial therapy for early-stage GML, an updated meta-analysis of available evidence is imperative. We performed a systematic review with proportional meta-analysis to assess the complete remission rate of H. pylori-positive early-stage GML after eradication therapy.