Helicobacter pylori and gastric mucosa-associated lymphoid tissue lymphoma: Recent progress in pathogenesis and management

Table 1 Lugano staging system for gastrointestinal lymphomas

Stage	Definition	Description
Stage I	Tumor confined to gastrointestinal tract	Single primary site or multiple, non contiguous lesions
Stage II	Tumor extending into abdomen from primary gastrointestinal site
	Nodal involvement
	II1 local	Paragastric (gastric cases) or paraintestinal (intestinal cases) nodal involvement
	II2 distant	Mesenteric, paraaoritic, paracaval, pelvic or inguinal nodal involvement
Stage IIE	Penetration of serosa to involve adjacent organs or tissues	Gastrointestinal lesion extending to involve adjacent organs, i.e., penetration, direct invasion, perforation or peritonitis by lymphoma
Stage IV	Disseminated extranodal involvement, or supra-diaphragmatic nodal involvement	Cases with Ann-Arbor stage III disease should be included

Rohatiner et al[31] with modification.

Table 2 Groupe d’Etude des Lymphomes de l’Adulte histological grading system for post-treatment evaluation of gastric mucosa-associated lymphoid tissue lymphoma

Score	Lymphoid infiltrate	LEL	Stromal changes	Clinical significance
CR	Absent or scattered plasma cells and small lymphoid cells in the LP	Absent	Normal or empty LP and/or fibrosis	Complete remission
pMRP	Aggregates of lymphoid cells or lymphoid nodules in LP/MM and/or SM	Absent	Empty LP and/or fibrosis	Complete remission
rRD	Dense, diffuse or nodular extending around glands in the LP	Focal LEL or absent	Focal empty LP and/or fibrosis	Partial remission
NC	Dense, diffuse or nodular	Present, “may be absent”	No changes	Stable disease or progressive disease

Copie-Bergman et al[34] with modification[26]. LEL: Lymphoepithelial lesions; LP: Lamina propria; MM: Muscularis propria; SM: Submucosa; CR: Complete histological response; pMRP: Probable minimal residual disease; rRD: Responding residual disease; NC: No change.

Table 3 Review of literature on efficacy of Helicobacter pylori eradication for gastric mucosa-associated lymphoid tissue lymphoma n (%)

Author, yr	Patients	CR cases	Median FW (yr)	PD	Relapse	Treatment failure1
Hancock et al, 2009	199	92 (46)	ND	ND	ND	25 (13)
Wündisch et al, 2006	193	146 (76)	2.3	0	5 (3.1)	5 (2.6)
Wündisch et al, 2005	120	96 (80)	6.3	0	3 (3.1)	3 (2.5)
Stathis et al, 2009	102	66 (65)	6.3	ND	ND	16 (16)
Kim et al, 2007	99	84 (85)	3.4	0	5 (5.9)	5 (5.1)
Nakamura et al, 2005	96	62 (65)	3.2	7 (7.3)	4 (6.4)	11 (11)
Hong et al, 2006	90	85 (94)	3.8	0	8 (9.4)	8 (8.9)
Fischbach et al, 2004	88	73 (83)	3.8	2 (2.3)	4 (5.5)	6 (6.8)
Nakamura et al, 2008	87	57 (66)	3.5	1 (1.1)	1 (1.8)	2 (2.3)
Savio et al, 2000	76	71 (93)	2.3	0	6 (8.5)	6 (7.9)
Terai et al, 2008	74	66 (89)	3.9	0	3 (4.5)	3 (4.1)
Sumida et al, 2009	66	47 (71)	3.3	0	0	0
Weston et al, 1999	58	40 (69)	1.8	0	0	0
Ono et al, 2010	58	48 (83)	6.3	2 (3.4)	1 (2.1)	3 (5.2)
Andriani et al, 2009	53	42 (79)	5.4	0	9 (21)	9 (17)
Akamatsu et al, 2006	47	30 (64)	3.1	1 (2.1)	1 (3.4)	2 (4.3)
Pinotti et al, 1997	44	30 (68)	1.8	0	2 (6.7)	2 (4.6)
Urakami et al, 2000	44	42 (95)	1.7	0	0	0
Ruskoné-Fourmestraux et al, 2001	44	19 (43)	2.9	1 (2.3)	2 (11)	3 (6.8)
Steinbach et al, 1999	34	14 (41)	3.4	2 (5.9)	0	2 (5.9)
Takenaka et al, 2004	33	26 (79)	ND	0	0	0
Chen et al, 2005	32	24 (75)	5.8	0	3 (13)	3 (9.4)
Lee et al, 2004	28	24 (86)	2.0	0	1 (4.2)	1 (3.6)
Montalban et al, 2005	24	22 (92)	4.6	0	1 (4.5)	1 (4.2)
de Jong et al, 2001	23	13 (57)	3.1	1 (4.3)	0	1 (4.4)
Raderer et al, 2001	22	15 (68)	2.1	0	1 (6.7)	1 (4.6)
Dong et al, 2008	22	13 (59)	1.5	0	0	0
Yamashita et al, 2000	21	14 (67)	0.8	0	0	0
Total of above	1877	1361 (73)	3.3	17 (1.12)	60 (4.93)	118 (6.3)
Nakamura et al[7], 2012	420	323 (77)	6.04	27 (6.4)	10 (3.1)	37 (8.8)

¹Progressive disease (PD) or relapse;

²17/1576 patients;

³60/1203 complete remission (CR) patients (Nakamura et al[7] with modification). FW: Follow-up; ND: Not described.