放疗对早期弥漫大B细胞淋巴瘤化疗后CR患者的价值研究

Clinical value of radiotherapy in early DLBCL patients with complete remission after chemotherapy

目的 探讨放疗在早期弥漫大B细胞淋巴瘤（DLBCL）化疗后达CR患者中的地位.方法 回顾分析2004-2012年本院治疗的376例Ⅰ、Ⅱ期DLBCL患者资料,均接受至少3个周期CHOP和利妥昔单抗＋CHOP方案化疗（R-CHOP）后达CR者.R-CHOP组92例,R-CHOP＋放疗组79例,CHOP＋放疗组98例,CHOP组107例.放疗为累及野照射30 ～ 56 Gy.Kaplan-Meier法计算生存率并Logrank法检验,Cox回归模型多因素预后分析.结果 5年样本量为188例.全组5年DFS、OS分别为80.7％、87.6％,R-CHOP＋放疗组和R-CHOP组的分别为94.9％和88.1％ （P=0.030）、97.9％和86.0％ （P=0.026）,CHOP＋放疗组和CHOP组的分别为74.2％和71.4％ （P=0.623）、87.0％和82.1％ （P =0.420）.多因素分析显示吸烟指数＜500、IPI ＜2、加用利妥昔单抗是预后有利因素（P =0.034～0.000）.结论 放疗对早期DLBCL可以提高R-CHOP化疗后CR者的DFS和OS.建议DLBCL使用含利妥昔单抗的化疗,R-CHOP化疗后应接受放疗.希望开展随机对照研究进一步证明该结果.

Objective To investigate the value of radiotherapy （RT） in patients with early diffuse large B-cell lymphoma （DLBCL） who have achieved a complete remission （CR） after chemotherapy.Methods A retrospective analysis was performed on 376 patients with stage Ⅰ and Ⅱ DLBCL who were admitted to our hospital from 2004 to 2012.All patients achieved a CR after receiving chemotherapy with cyclophosphamide,doxorubicin/epirubicin,vincristine and prednisone （CHOP） or rituximab combined with CHOP （R-CHOP） for at least three cycles.The median age was 53 years.Patients were divided into four groups：R-CHOP group （n =92）,R-CHOP ＋ RT group （n =79）,CHOP group （n =107）,and CHOP ＋ RT group （n =98）.The RT used was involved-field irradiation and the total dose ranged from 30 to 56 Gy.The survival rate was determined using the Kaplan-Meier method,and the survival difference analysis was performed using the log-rank test.Multivariate prognostic analysis was performed using the Cox proportional hazard model.Results The 5-year sample size was 188.The 5-year disease-free survival （DFS） and overall survival （OS） rates in all patients were 80.7% and 87.6%,respectively.The 5-year DFS and OS rates in the R-CHOP ＋ RT group were significantly higher than those in the R-CHOP group （94.9% vs.88.1%,P =0.030;97.9% vs.86.0%,P=0.026）.No significant differences in DFS and OS rates were observed between the CHOP ＋ RT and CHOP groups （74.2% vs.71.4%,P =0.623 ;74.2% vs.71.4%,P =0.623）.Multivariate prognostic analysis revealed that the smoking index 〈 500,international prognostic index 〈 2,and use of rituximab were favorable prognostic factors （P =0.034-0.000）.Conclusions Radiotherapy can improve the DFS and OS in early DLBCL patients with CR after R-CHOP chemotherapy.All early stage DLBCL patients are recommended to undergo rituximab-containing chemotherapy followed by radiotherapy.Randomized controlled trials are needed to validate the results.