Abstract:  Primary gastric lymphomas account for 4.6% of non-Hodgkin lymphomas ( NHL ). Over the past several years, significant attention has been paid to the gastric mucosa-associated lymphoid tissues ( MALT ), a low-grade gastric B cell lymphoma, due to a close correlation between the incidence of MALT and Helicobacter pylori infection. The aim of the present study was to discuss the clinical features, pathological diagnosis, and therapeutic regimen of gastric MALT lymphoma. Methods: Clinicopathologic features and data of clinical stages of 42 patients with gastric MALT lymphoma, who were admitted to Tianjin Medical University Cancer Institute and Hospital between July 1990 and May 2008, were retrospectively analyzed. The cases were divided according to the treatment administered, namely, 7 patients by H. pylori eradication, 9 by surgery, 20 by surgery plus H. pylori eradication, and 6 by surgery plus chemotherapy or radiotherapy. The Kaplan-Meier method was used to analyze the survival rates, and the Log rank test was performed to assess the statistical significance among the groups. Results: All patients received gastroscopy and biopsy. However, only 11 of the 42 patients ( 26.2% ) were pathologically confirmed. H. pylori strain was positive in 24 of 34 patients ( 70.6% ). The results of the immunophenotypic analysis confirmed these tumors to be B-cell lymphoma. Based on the Cotswolds modification of the Ann Arbor Staging System, 17 of the cases were at stage IE2, 16 at stage IIE1, 6 at stage IIE2, two at stage IIE, and one at stage IV, respectively. Survival analysis indicated that the 5-year survival rates were 100%, 83.7%, 82.4%, and 43.0%, respectively, in the 4 groups ( P = 0.027 ). Conclusion: There are no remarkable characteristics in the clinical manifestation and auxiliary examination of the gastric MALT lymphoma. Thus, very few patients received surgery at the initial treatment, choosing either Hp eradication or radiotherapy instead. Hp eradication should be recommended as the first-line therapy after a final diagnosis is made by pathology, because its clinical effects are equal to those of surgery. For a patient with advanced gastric MALT lymphoma, combined therapy, such as chemoradiotherapy, can be conducted after surgery. However, long-term survival rates may be relatively poor, compared with those of patients with early-stage lesions.