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早期韦氏环弥漫大B细胞淋巴瘤预后分析
李环, 吴涛, 刘秋琳, 张婧, 胡云飞, 陈梦翔, 黄韵红, 卢冰
贵州医科大学 贵州医科大学附属肿瘤医院肿瘤科 贵州省肿瘤医院淋巴瘤科,贵阳550001
Prognostic and survival analyses of early-stage diffuse large B-cell lymphoma of Waldeyer′s ring
Li Huan, Wu Tao, Lin Qiulin, Zhang Jing, Hu Yunfei, Chen Mengxiang, Huang Yunhong, Lu Bing
Guizhou Medical University,Department of Oncology,The Affiliated Cancer Hospital of Guizhou Medical University,Department of Lymphoma,Guizhou Cancer Hospital,Guiyang 550001,China
Abstract：Objective To analyze the clinical efficacy and prognostic factors of patients with early-stage diffuse large B-cell lymphoma of Waldeyer′s ring (WR-DLBCL) treated with CHOP-based chemotherapy. Methods A total of 137 patients diagnosed with WR-DLBCL admitted to our hospitalfrom 2006 to 2018 were enrolled,including 22 patients with stage Ⅰ and 115 patients with stage Ⅱ WR-DLBCL. All patients received CHOP-based chemotherapy,of whom 62 receiving rituximab and 87 receiving involved-field radiotherapy. The overall survival (OS),progression-free survival (PFS) and local recurrence-free survival (LRRFS) were calculated by Kaplan-Meier method. Log-rank test,was conducted for univariate analysis and Cox’s regression model was performed for multivariate analysis. Results The 5-year OS,PFS,and LRFFS in the whole group were 78.6%,69.5% and 83.2%,and 87.5%,80.2%,90.9% in the comprehensive treatment group,and 64.2%,53.6% 72.9% in the chemotherapy group,respectively. Univariate analysis showed that lactate dehydrogenase (LDH),international prognostic index score,large mass,rituximab,chemotherapy cycle and comprehensive treatment were the prognostic factors of OS and PFS. In addition,LDH,large mass and comprehensive treatment were the prognostic factors associated with LRFFS. Multivariate analysis demonstrated that LDH,comprehensive treatment mode and rituximab were the prognostic factors of OS. LDH and comprehensive treatment mode were the prognostic factors associated with PFS. LDH was a prognostic factor of LRFFS. Conclusion Patients with early-stage WR-BLBCL obtain excellent clinical prognosis. In the era of rituximab treatment,chemotherapy combined with radiotherapy remains an efficacious treatment of early-stage WR-BLBCL.
Li Huan,Wu Tao,Lin Qiulin et al. Prognostic and survival analyses of early-stage diffuse large B-cell lymphoma of Waldeyer′s ring[J]. Chinese Journal of Radiation Oncology, 2019, 28(12): 896-900.
[1]Coiffier B,Thieblemont C,Van Den Neste E,et al. Long-term outcome of patients in the LNH-98.5 trial,the first randomized study comparing rituximab-CHOP to standard CHOP chemotherapy in DLBCL patients:a study by the Groupe d′Etudes des Lymphomes de l′Adulte[J]. Blood,2010,116(12):2040-2045. DOI:10.1182/blood-2010-03-276246. [2]Laurie H,Sehn R,Gascoyne D. Diffuse large B-cell lymphoma:optimizing outcome in the context of clinical and biologic heterogeneity[J]. Blood,2015,125(1):22-32. DOI 10.1182/blood-2014-05-577189. [3]Tan L. Lymphomas involving Waldeyer′s ring:placement,paradigms,peculiarities,pitfalls,patterns and postulates[J]. Ann Acad Med Singapore,2004,33(4 Suppl):15-26. [4]李晔雄,高远红,袁智勇,国际预后指数在韦氏环非霍奇金淋巴瘤的预后意义[J]. 中华放射肿瘤学杂志,2002,11(2):105-110. Li YX,Gao YH,Yuan ZhY. Prognostic significance of international prognostic index in non-Hodgkin′′s lymphoma of Waldeyer′′s ring[J]. Chin J Radiat Oncol,2002,11(2):105-110. [5]Qi SN,Li YX,Wang H,et al. Diffuse large B-cell lymphoma:clinical characterization and prognosis of Waldeyer ring versus lymph node presentation[J]. Cancer,2009,115(21):4980-9. DOI:10.1002/cncr.24557. [6]Pfreundschuh M,Kuhnt E,Trümper L,et al,CHOP-like chemotherapy with or without rituximab in young patients with good-prognosis diffuse large-B-cell lymphoma:6-year results of an open-label randomised study of the MabThera International Trial (MInT) Group[J]. Lancet Oncol,2011,12(11):1013-1022. DOI:10.1016/S1470-2045(11)70235-2. [7]Christine PH,Dennis DW,Timothy C,et al,Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray[J]. Blood,2004,103(1):275-282. DOI:10.1182/blood-2003-05-1545. [8]Bruce DC,Richard IF,Sally FB,et al. Recommendations for initial evaluation,staging,and response assessment of Hodgkin and non-Hodgkin lymphoma:the Lugano classification[J]. J Clin Oncol,2014,32(27):3059-3068. DOI:10.1200/JCO.2013.54.8800. [9]Savage KJ,Johnson NA. MYC gene rearrangements are associated with a poor prognosis in diffuse large B-cell lymphoma patients treated with R-CHOP chemotherapy[J]. Blood,2009,114(17):3533-7. DOI:10.1182/blood-2009-05-220095. [10]Tilly H, Gomes da Silva M, Vitolo U,et al.Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J].Ann Oncol. 2015 ,26 Suppl 5:v116-25.doi:10.1093/annonc/mdv304. [11]Pfreundschuh M,Trümper L,Osterborg A,et al. CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma:a randomised controlled trial by the MabThera International Trial (MInT) Group[J]. Lancet Oncol,2006,7(5):379-391. DOI:10.1016/S1470-2045(06) 70664-7. [12]Pfreundschuh M,Ho AD,Cavallin-Stahl E,et al., Prognostic significance of maximum tumour (bulk) diameter in young patients with good-prognosis diffuse large-B-cell lymphoma treated with CHOP-like chemotherapy with or without rituximab:an exploratory analysis of the MabThera International Trial Group (MInT) study[J]. Lancet Oncol,2008,9(5):435-444. DOI:10.1016/S1470-2045(08)70078-0. [13]Pugh TJ,Ballonoff A,Rusthoven KE,et al., Cardiac mortality in patients with stage Ⅰ and Ⅱ diffuse large B-cell lymphoma treated with and without radiation:a surveillance,epidemiology,and end-results analysis[J]. Int J Radiat Oncol Biol Phys,2010,76(3):845-849. DOI:10.1016/j.ijrobp.2009.02.045. [14]Ng AK,Dabaja BS,Hoppe RT,et al. Re-Examining the Role of Radiation Therapy for Diffuse Large B-Cell Lymphoma in the Modern Era[J]. J Clin Oncol,2016,34(13):1443-1447. DOI:10.1200/JCO.2015.64.9418. [15]Mian M,Ferreri AJ,Rossi A,et al. Role of radiotherapy in patients with early-stage diffuse large B-cell lymphoma of Waldeyer′s ring in remission after anthracycline-containing chemotherapy[J]. Leuk Lymphoma,2013,54(1):62-68. DOI:10.3109/10428194.2012.710907. [16]徐勇刚,李晔雄. 韦氏环弥漫大B细胞淋巴瘤放疗的临床结果和剂量学研究[D]. 北京:北京协和医学院,2016. Xu YG,Li YX. Clinical results and dosimetry of radiotherapy for diffuse large B-cell lymphoma in Wechsler′s ring[D]. Beijing:Peking Union Medical College, 2016. [17]Phan J,Mazloom A,Medeiros LJ,et al. Benefit of consolidative radiation therapy in patients with diffuse large B-cell lymphoma treated with R-CHOP chemotherapy[J]. J Clin Oncol,2010,28(27):4170-4176. DOI:10.1200/JCO.2009.27.3441. [18]Vargo JA,Gill BS,Balasubramani GK,et al. Treatment Selection and Survival Outcomes in Early-Stage Diffuse Large B-Cell Lymphoma:Do We Still Need Consolidative Radiotherapy?[J]. J Clin Oncol,2015,33(32):3710-3717. DOI:10.1200/JCO.2015.61.7654. [19]Grass GD,Mills MN,Ahmed KA,et al. Radiotherapy for early stage diffuse large B-cell lymphoma with or without double or triple hit genetic alterations[J]. Leuk Lymphoma,2019,60(4):886-893. DOI:10.1080/10428194.2018.1506586. [20]Shi Y,Han Y,yang J,et al. Clinical features and outcomes of diffuse large B-cell lymphoma based on nodal or extranodal primary sites of origin:Analysis of 1,085 WHO classified cases in a single institution in China[J]. Chin J Cancer Res,2019,31(1):152-161. DOI:10.21147/j.issn.1000-9604.2019.01.10.
2019, Vol. 28 
