# Radiotherapy is associated with improved survival in stage I–II gastric MALT lymphoma after failed or inadequate Helicobacter pylori eradication: a single-center retrospective study

## TL;DR

Radiotherapy improves survival in early-stage gastric MALT lymphoma when Helicobacter pylori treatment fails or isn't given.

## Contribution

This study shows radiotherapy alone is more effective than systemic therapy for gastric MALT lymphoma after H. pylori treatment failure.

## Key findings

- Radiotherapy alone improved progression-free and overall survival compared to systemic therapy alone.
- Combined radiotherapy and systemic therapy did not provide better survival than radiotherapy alone.
- Prior anti-H. pylori therapy, even if unsuccessful, may reduce recurrence risk.

## Abstract

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.

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.

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).

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.