nach oben

Erschienen in:

27.02.2021 | Original Article

Involvement of non-Helicobacter pylori helicobacter infections in Helicobacter pylori-negative gastric MALT lymphoma pathogenesis and efficacy of eradication therapy

verfasst von: Hidehiko Takigawa, Ryo Yuge, Satoshi Masaki, Rina Otani, Hiroki Kadota, Toshikatsu Naito, Ryohei Hayashi, Yuji Urabe, Shiro Oka, Shinji Tanaka, Kazuaki Chayama, Yasuhiko Kitadai

Erschienen in: Gastric Cancer | Ausgabe 4/2021

Einloggen, um Zugang zu erhalten

Abstract

Background

Eradication therapy is known to be effective against Helicobacter pylori-positive gastric MALT lymphoma but predicting the efficacy of eradication therapy against Helicobacter pylori-negative gastric MALT lymphoma is difficult. Recent reports have shown that non-Helicobacter pylori helicobacter infections induce gastric MALT lymphoma, and we aimed to clarify whether non-Helicobacter pylori helicobacter infections are associated with the efficacy of eradication therapy.

Methods

We analyzed eradication therapy as a first-line treatment for 182 cases of gastric MALT lymphoma, classified according to Helicobacter pylori infection and API2-MALT1 mutation status. We also evaluated the non-Helicobacter pylori helicobacter infection status in 29 Helicobacter pylori-negative cases via PCR with DNA extracted from paraffin-embedded biopsy tissues. Finally, we analyzed the relationship between non-Helicobacter pylori helicobacter infection status and eradication therapy outcome.

Results

The API2-MALT1 mutation was observed in 13/182 patients (7.1%), none of whom were cured by eradication therapy. Helicobacter pylori-negative cases had a significantly higher non-Helicobacter pylori helicobacter infection rate than Helicobacter pylori-positive cases (16/29, 55% vs. 3/29, 10%; P < 0.05). Among the Helicobacter pylori-negative cases, non-Helicobacter pylori helicobacter-positive cases had a significantly higher complete response rate than non-Helicobacter pylori helicobacter-negative cases (12/16, 75% vs. 3/13, 23%; P < 0.05).

Conclusion

Helicobacter pylori-negative and API2-MALT1-negative gastric MALT lymphoma cases exhibited a high rate of non-Helicobacter pylori helicobacter infections, which may have contributed to the success of eradication therapy. Therefore, we recommend eradication therapy as a first-line treatment for non-Helicobacter pylori helicobacter-positive gastric MALT lymphoma.

Herrmann R, Panahon AM, Barcos MP, Walsh D, Stutzman L. Gastrointestinal involvement in non-Hodgkin’s lymphoma. Cancer. 1980;46(1):215–22. https://doi.org/10.1002/1097-0142(19800701)46:1%3c215::aid-cncr2820460136%3e3.0.co;2-6 (PubMed PMID: 7388763).CrossRefPubMed

d’Amore F, Brincker H, Gronbaek K, Thorling K, Pedersen M, Jensen MK, et al. Non-Hodgkin’s lymphoma of the gastrointestinal tract: a population-based analysis of incidence, geographic distribution, clinicopathologic presentation features, and prognosis. Danish Lymphoma Study Group. J Clin Oncol. 1994;12(8):1673–84. https://doi.org/10.1200/JCO.1994.12.8.1673 (PubMed PMID: 8040680).CrossRefPubMed

Ghimire P, Wu GY, Zhu L. Primary gastrointestinal lymphoma. World J Gastroenterol. 2011;17(6):697–707. https://doi.org/10.3748/wjg.v17.i6.697 (PubMed PMID: 21390139; PubMed Central PMCID: PMCPMC3042647).CrossRefPubMedPubMedCentral

Nakamura S, Matsumoto T. Helicobacter pylori and gastric mucosa-associated lymphoid tissue lymphoma: recent progress in pathogenesis and management. World J Gastroenterol. 2013;19(45):8181–7. https://doi.org/10.3748/wjg.v19.i45.8181 (PubMed PMID: 24363507; PubMed Central PMCID: PMCPMC3857439).CrossRefPubMedPubMedCentral

Morgner A, Lehn N, Andersen LP, Thiede C, Bennedsen M, Trebesius K, et al. Helicobacter heilmannii-associated primary gastric low-grade MALT lymphoma: complete remission after curing the infection. Gastroenterology. 2000;118(5):821–8. https://doi.org/10.1016/S0016-5085(00)70167-3 (PubMed PMID: WOS:000086836400005).CrossRefPubMed

Okiyama Y, Matsuzawa K, Hidaka E, Sano K, Akamatsu T, Ota H. Helicobacter heilmannii infection: clinical, endoscopic and histopathological features in Japanese patients. Pathol Int. 2005;55(7):398–404. https://doi.org/10.1111/j.1440-1827.2005.01844.x (PubMed PMID: 15982214).CrossRefPubMed

O’Rourke JL, Dixon MF, Jack A, Enno A, Lee A. Gastric B-cell mucosa-associated lymphoid tissue (MALT) lymphoma in an animal model of “Helicobacter heilmannii” infection. J Pathol. 2004;203(4):896–903. https://doi.org/10.1002/path.1593 (PubMed PMID: 15258991).CrossRefPubMed

Haesebrouck F, Pasmans F, Flahou B, Chiers K, Baele M, Meyns T, et al. Gastric helicobacters in domestic animals and nonhuman primates and their significance for human health. Clin Microbiol Rev. 2009;22(2):202–23. https://doi.org/10.1128/CMR.00041-08 (Table of Contents. PubMed PMID: 19366912; PubMed Central PMCID: PMCPMC2668234).CrossRefPubMedPubMedCentral

Nakamura M, Overby A, Michimae H, Matsui H, Takahashi S, Mabe K, et al. PCR analysis and specific immunohistochemistry revealing a high prevalence of non-Helicobacter pylori Helicobacters in Helicobacter pylori-negative gastric disease patients in Japan: high susceptibility to an Hp eradication regimen. Helicobacter. 2020;25(5):e12700. https://doi.org/10.1111/hel.12700 (PubMed PMID: 32790220).CrossRefPubMed

10.

Debongnie JC, Donnay M, Mairesse J, Lamy V, Dekoninck X, Ramdani B. Gastric ulcers and Helicobacter heilmannii. Eur J Gastroenterol Hepatol. 1998;10(3):251–4. https://doi.org/10.1097/00042737-199803000-00011 (PubMed PMID: 9585030).CrossRefPubMed

11.

Joo M, Kwak JE, Chang SH, Kim H, Chi JG, Kim KA, et al. Helicobacter heilmannii-associated gastritis: clinicopathologic findings and comparison with Helicobacter pylori-associated gastritis. J Korean Med Sci. 2007;22(1):63–9. https://doi.org/10.3346/jkms.2007.22.1.63 (PubMed PMID: 17297253; PubMed Central PMCID: PMCPMC2693570).CrossRefPubMedPubMedCentral

12.

Holck S, Ingeholm P, Blom J, Norgaard A, Elsborg L, Adamsen S, et al. The histopathology of human gastric mucosa inhabited by Helicobacter heilmannii-like (Gastrospirillum hominis) organisms, including the first culturable case. APMIS. 1997;105(10):746–56. https://doi.org/10.1111/j.1699-0463.1997.tb05080.x (PubMed PMID: 9368589).CrossRefPubMed

13.

Ierardi E, Monno RA, Gentile A, Francavilla R, Burattini O, Marangi S, et al. Helicobacter heilmannii gastritis: a histological and immunohistochemical trait. J Clin Pathol. 2001;54(10):774–7. https://doi.org/10.1136/jcp.54.10.774 (PubMed PMID: 11577125; PubMed Central PMCID: PMCPMC1731280).CrossRefPubMedPubMedCentral

14.

Morgner A, Bayerdorffer E, Neubauer A, Stolte M. Malignant tumors of the stomach. Gastric mucosa-associated lymphoid tissue lymphoma and Helicobacter pylori. Gastroenterol Clin North Am. 2000;29(3):593–607 (PubMed PMID: 11030075).CrossRef

15.

Enno A, O’Rourke JL, Howlett CR, Jack A, Dixon MF, Lee A. MALToma-like lesions in the murine gastric mucosa after long-term infection with Helicobacter felis A mouse model of Helicobacter pylori-induced gastric lymphoma. Am J Pathol. 1995;147(1):217–22 (PubMed PMID: 7604881; PubMed Central PMCID: PMCPMC1869885).PubMedPubMedCentral

16.

Goji S, Tamura Y, Sasaki M, Nakamura M, Matsui H, Murayama SY, et al. Helicobacter suis-Infected nodular gastritis and a review of diagnostic sensitivity for Helicobacter heilmannii-like organisms. Case Rep Gastroenterol. 2015;9(2):179–87. https://doi.org/10.1159/000431169 (PubMed PMID:26120299; PubMed Central PMCID: PMCPMC4478311).CrossRefPubMedPubMedCentral

17.

Heilmann KL, Borchard F. Gastritis due to spiral shaped bacteria other than Helicobacter-Pylori—clinical, histological, and ultrastructural findings. Gut. 1991;32(2):137–40. https://doi.org/10.1136/gut.32.2.137 (PubMed PMID: WOS:A1991EW53800005).CrossRefPubMedPubMedCentral

18.

Solnick JV, Orourke J, Lee A, Paster BJ, Dewhirst FE, Tompkins LS. An uncultured gastric spiral organism is a newly identified helicobacter in humans. J Infect Dis. 1993;168(2):379–85. https://doi.org/10.1093/infdis/168.2.379 (PubMed PMID: WOS:A1993LN81300018).CrossRefPubMed

19.

De Groote D, van Doorn LJ, Ducatelle R, Verschuuren A, Haesebrouck F, Quint WGV, et al. “Candidatus Helicobacter suis”, a gastric helicobacter from pigs, and its phylogenetic relatedness to other gastrospirilla. Int J Syst Bacteriol. 1999;49:1769–77. https://doi.org/10.1099/00207713-49-4-1769 (PubMed PMID: WOS:000083450800050).CrossRefPubMed

20.

Baele M, Decostere A, Vandamme P, Ceelen L, Hellemans A, Mast J, et al. Isolation and characterization of Helicobacter suis sp nov from pig stomachs. Int J Syst Evol Micr. 2008;58:1350–8. https://doi.org/10.1099/ijs.0.65133-0 (PubMed PMID: WOS:000257277200014).CrossRef

21.

O’Rourke JL, Solnick JV, Neilan BA, Seidel K, Hayter R, Hansen LM, et al. Description of “Candidatus Helicobacter heilmannii” based on DNA sequence analysis of 16S rRNA and urease genes. Int J Syst Evol Micr. 2004;54:2203–11. https://doi.org/10.1099/ijs.0.63117-0 (PubMed PMID: WOS:000225366000052).CrossRef

22.

Smet A, Flahou B, D’Herde K, Vandamme P, Cleenwerck I, Ducatelle R, et al. Helicobacter heilmannii sp. Nov., isolated from feline gastric mucosa. Int J Syst Evol Micr. 2012;62:1016. https://doi.org/10.1099/ijs.0.68146-0 (PubMed PMID: WOS:000303487100048).CrossRef

23.

Masaki S, Takigawa H, Kunisho S, Kimoto A, Yuge R, Tanaka S, et al. Association between Helicobacter suis infection and the pathogenesis of gastric mucosa-associated lymphoid tissue lymphoma. Hiroshima J Med Sci. 2020;69(2):33–7. https://doi.org/10.24811/hjms.69.2_33.CrossRef

24.

Asano N, Iijima K, Koike T, Imatani A, Shimosegawa T. Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphomas: a review. World J Gastroenterol. 2015;21(26):8014–20. https://doi.org/10.3748/wjg.v21.i26.8014 (PubMed PMID: 26185372; PubMed Central PMCID: PMCPMC4499343).CrossRefPubMedPubMedCentral

25.

Choi YJ, Kim N, Paik JH, Kim JM, Lee SH, Park YS, et al. Characteristics of Helicobacter pylori-positive and Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma and their influence on clinical outcome. Helicobacter. 2013;18(3):197–205. https://doi.org/10.1111/hel.12033 (PubMed PMID: 23305046).CrossRefPubMed

26.

Nakamura S, Sugiyama T, Matsumoto T, Iijima K, Ono S, Tajika M, et al. Long-term clinical outcome of gastric MALT lymphoma after eradication of Helicobacter pylori: a multicentre cohort follow-up study of 420 patients in Japan. Gut. 2012;61(4):507–13. https://doi.org/10.1136/gutjnl-2011-300495 (PubMed PMID: 21890816).CrossRefPubMed

27.

Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016;127(20):2375–90. https://doi.org/10.1182/blood-2016-01-643569 (PubMed PMID: 26980727; PubMed Central PMCID: PMCPMC4874220).CrossRefPubMedPubMedCentral

28.

Wotherspoon AC, Ortizhidalgo C, Falzon MR, Isaacson PG. Helicobacter-Pylori-associated gastritis and primary B-Cell GASTRIC LYMPHOMa. Lancet. 1991;338(8776):1175–6. https://doi.org/10.1016/0140-6736(91)92035-Z (PubMed PMID: WOS:A1991GP03400007).CrossRefPubMed

29.

Copie-Bergman C, Gaulard P, Lavergne-Slove A, Brousse N, Flejou JF, Dordonne K, et al. Proposal for a new histological grading system for post-treatment evaluation of gastric MALT lymphoma. Gut. 2003;52(11):1656. https://doi.org/10.1136/gut.52.11.1656 (PubMed PMID: WOS:000186070800023).CrossRefPubMedPubMedCentral

30.

Musshoff K. Clinical staging classification of non-Hodgkin’s lymphomas (author’s transl). Strahlentherapie. 1977;153(4):218–21 (PubMed PMID: 857349).PubMed

31.

Streubel B, Lamprecht A, Dierlamm J, Cerroni L, Stolte M, Ott G, et al. T(14;18)(q32;q21) involving IGH and MALT1 is a frequent chromosomal aberration in MALT lymphoma. Blood. 2003;101(6):2335–9. https://doi.org/10.1182/blood-2002-09-2963 (PubMed PMID: WOS:000181432600041).CrossRefPubMed

32.

Akagi T, Motegi M, Tamura A, Suzuki R, Hosokawa Y, Suzuki H, et al. A novel gene, MALT1 at 18q21, is involved in t(11;18) (q21;q21) found in low-grade B-cell lymphoma of mucosa-associated lymphoid tissue. Oncogene. 1999;18(42):5785–94. https://doi.org/10.1038/sj.onc.1203018 (PubMed PMID: WOS:000083095100007).CrossRefPubMed

33.

Cho CJ, Kang HJ, Ryu YM, Park YS, Jeong HJ, Park YM, et al. Poor prognosis in Epstein-Barr virus-negative gastric cancer with lymphoid stroma is associated with immune phenotype. Gastric Cancer. 2018;21(6):925–35. https://doi.org/10.1007/s10120-018-0820-3 (PubMed PMID: 29627937).CrossRefPubMed

34.

Liu J, He L, Haesebrouck F, Gong Y, Flahou B, Cao Q, et al. Prevalence of Coinfection with Gastric Non-Helicobacter pylori Helicobacter (NHPH) Species in Helicobacter pylori-infected Patients Suffering from Gastric Disease in Beijing, China. Helicobacter. 2015;20(4):284–90. https://doi.org/10.1111/hel.12201 (PubMed PMID: 25510739).CrossRefPubMed

35.

Takigawa H, Masaki S, Naito T, Yuge R, Urabe Y, Tanaka S, et al. Helicobacter suis infection is associated with nodular gastritis-like appearance of gastric mucosa-associated lymphoid tissue lymphoma. Cancer Med. 2019;8(9):4370–9. https://doi.org/10.1002/cam4.2314 (PubMed PMID: 31210418; PubMed Central PMCID: PMCPMC6675707).CrossRefPubMedPubMedCentral

36.

Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2012;48:452. https://doi.org/10.1038/bmt.2012.244.CrossRefPubMedPubMedCentral

37.

Jhala D, Jhala N, Lechago J, Haber M. Helicobacter heilmannii gastritis: association with acid peptic diseases and comparison with Helicobacter pylori gastritis. Mod Pathol. 1999;12(5):534–8 (PubMed PMID: 10349993).PubMed

38.

Hilzenrat N, Lamoureux E, Weintrub I, Alpert E, Lichter M, Alpert L. Helicobacter heilmannii-like spiral bacteria in gastric mucosal biopsies. Prevalence and clinical significance. Arch Pathol Lab Med. 1995;119(12):1149–53 (PubMed PMID: 7503664).PubMed

39.

Nakamura M, Murayama SY, Serizawa H, Sekiya Y, Eguchi M, Takahashi S, et al. “Candidatus Helicobacter heilmannii” from a cynomolgus monkey induces gastric mucosa-associated lymphoid tissue lymphomas in C57BL/6 mice. Infect Immun. 2007;75(3):1214–22. https://doi.org/10.1128/IAI.01459-06 (PubMed PMID: 17194807; PubMed Central PMCID: PMCPMC1828597).CrossRefPubMed

40.

Okamura T, Iwaya Y, Yokosawa S, Suga T, Arakura N, Matsumoto T, et al. A case of Helicobacter heilmannii-associated primary gastric mucosa-associated lymphoid tissue lymphoma achieving complete remission after eradication. Clin J Gastroenterol. 2013;6(1):38–45. https://doi.org/10.1007/s12328-012-0355-9 (PubMed PMID: 26181403).CrossRefPubMed

41.

Yamamoto T, Matsumoto J, Shiota K, Kitajima S, Goto M, Imaizumi M, et al. Helicobacter heilmannii associated erosive gastritis. Intern Med. 1999;38(3):240–3. https://doi.org/10.2169/internalmedicine.38.240 (PubMed PMID: 10337933).CrossRefPubMed

42.

Peterson RA, Danon SJ, Eaton KA. Comparison of gastritis and gastric epithelial proliferation in Helicobacter heilmannii-infected nude and BALB/c mice. Vet Pathol. 2001;38(2):173–83. https://doi.org/10.1354/vp.38-2-173 (PubMed PMID: 11280373).CrossRefPubMed

43.

Nobutani K, Yoshida M, Nishiumi S, Nishitani Y, Takagawa T, Tanaka H, et al. Helicobacter heilmannii can induce gastric lymphoid follicles in mice via a Peyer’s patch-independent pathway. FEMS Immunol Med Microbiol. 2010;60(2):156–64. https://doi.org/10.1111/j.1574-695X.2010.00731.x (PubMed PMID: 20846360).CrossRefPubMed

44.

Iwamuro M, Tanaka T, Nishida K, Kanzaki H, Kawano S, Kawahara Y, et al. Two cases of gastric mucosa-associated lymphoid tissue (MALT) lymphoma masquerading as follicular gastritis. Ecancermedicalscience. 2019;13:933. https://doi.org/10.3332/ecancer.2019.933 (PubMed PMID: 31281430; PubMed Central PMCID: PMCPMC6605631).CrossRefPubMedPubMedCentral

Titel: Involvement of non-Helicobacter pylori helicobacter infections in Helicobacter pylori-negative gastric MALT lymphoma pathogenesis and efficacy of eradication therapy
verfasst von: Hidehiko Takigawa
Ryo Yuge
Satoshi Masaki
Rina Otani
Hiroki Kadota
Toshikatsu Naito
Ryohei Hayashi
Yuji Urabe
Shiro Oka
Shinji Tanaka
Kazuaki Chayama
Yasuhiko Kitadai
Publikationsdatum: 27.02.2021
Verlag: Springer Singapore
Erschienen in: Gastric Cancer / Ausgabe 4/2021
Print ISSN: 1436-3291
Elektronische ISSN: 1436-3305
DOI: https://doi.org/10.1007/s10120-021-01172-x

Neu im Fachgebiet Chirurgie

Wie sieht der OP der Zukunft aus?

04.05.2024 DCK 2024 Kongressbericht

Der OP in der Zukunft wird mit weniger Personal auskommen – nicht, weil die Technik das medizinische Fachpersonal verdrängt, sondern weil der Personalmangel es nötig macht.

Umsetzung der POMGAT-Leitlinie läuft

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Recycling im OP – möglich, aber teuer

02.05.2024 DCK 2024 Kongressbericht

Auch wenn sich Krankenhäuser nachhaltig und grün geben – sie tragen aktuell erheblich zu den CO₂-Emissionen bei und produzieren jede Menge Müll. Ein Pilotprojekt aus Bonn zeigt, dass viele Op.-Abfälle wiederverwertet werden können.

Ambulantisierung: Erste Erfahrungen mit dem Hybrid-DRG

02.05.2024 DCK 2024 Kongressbericht

Die Hybrid-DRG-Verordnung soll dazu führen, dass mehr chirurgische Eingriffe ambulant durchgeführt werden, wie es in anderen Ländern schon länger üblich ist. Die gleiche Vergütung im ambulanten und stationären Sektor hatten Niedergelassene schon lange gefordert. Aber die Umsetzung bereitet ihnen doch Kopfzerbrechen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Background

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2021

Drug-exposed cancer-associated fibroblasts facilitate gastric cancer cell progression following chemotherapy

Comment on: “Long‑term persistence of gastric dysbiosis after eradication of Helicobacter pylori in patients who underwent endoscopic submucosal dissection for early gastric cancer. Gastric Cancer, 2020 Nov 17” by Watanabe et al.

Hospital volume following major surgery for gastric cancer determines in-hospital mortality rate and failure to rescue: a nation-wide study based on German billing data (2009–2017)

Discovery and development of trastuzumab deruxtecan and safety management for patients with HER2-positive gastric cancer

Personalized therapeutic strategies in HER2-driven gastric cancer

Different effects of p53 protein overexpression on the survival of gastric cancer patients according to Lauren histologic classification: a retrospective study

Update Chirurgie