ORIGINAL RESEARCH article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
Radiotherapy is Associated with Survival in Stage I-II Gastric MALT Lymphoma with Failed or Inadequate Anti-Helicobacter Pylori Treatment: A Single-Center Retrospective Analysis
Provisionally accepted
- 1The Central Hospital of Wuhan, Wuhan, China
- 2Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, China
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Objective: To investigate the impact of different first-line anti-tumor therapies on survival outcomes in patients with stage I-II gastric MALT lymphoma who failed or did not receive anti-Helicobacter pylori (H. pylori) therapy. Methods: Clinical data from 144 patients with anti-H. pylori therapy-failed or -naïve stage I-II gastric MALT lymphoma treated at Sun Yat-sen University Cancer Center between June 1998 and July 2021 were retrospectively analyzed. Patients were divided into three groups based on first-line treatment: systemic therapy alone radiotherapy alone, and radiotherapy combined with systemic therapy. Kaplan-Meier analysis and log-rank tests were used to compare progression-free survival (PFS) and overall survival (OS) among groups. Univariate and multivariate Cox regression analyses were performed to identify independent prognostic factors. Results: Significant differences were observed among the three groups regarding staging, H. pylori status, prior anti-H. pylori therapy, elevated LDH, Ki67%, and CD20+ expression (p < 0.05). With a median follow-up of 59 months (IQR: 35–101 months), the radiotherapy-alone group (n = 56) demonstrated superior PFS (p = 0.001) and OS (p = 0.031) compared to the systemic therapy-alone group (n = 39). No significant differences in PFS (p = 0.358) or OS (p = 0.386) were observed between the radiotherapy-alone and combined therapy groups (n= 49). Stratification by radiotherapy dose (≤30 Gy, 31–35 Gy, 36–42 Gy) revealed no survival differences (p > 0.05). Univariate analysis identified low LDH, low MALT-IPI score, prior anti-H. pylori therapy, and radiotherapy (alone or combined) as protective factors against recurrence (p < 0.05). However, multivariate analysis confirmed only radiotherapy (alone or combined) as independent predictors of reduced recurrence (p < 0.05). Conclusion: Radiotherapy remains the highly effective option for anti-H. pylori therapy-failed or -naïve stage I-II gastric MALT lymphoma. Combined therapy provided no additional survival benefit over radiotherapy alone. Notably, prior (even failed) anti-H. pylori therapy may reduce recurrence risk, warranting further validation.
Keywords: failed or deficient anti Helicobacter pyloritreatment, Gastric MALT lymphoma, Radiotherapy, Retrospective study, survival prognosis
Received: 19 Aug 2025; Accepted: 29 Nov 2025.
Copyright: © 2025 Li, Wang, Lu and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Chi Lu
Yujing Zhang
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