放疗在美罗华时代对局限期原发韦氏环弥漫大B细胞淋巴瘤的治疗价值

The role of radiotherapy in limited-stage primary diffuse large B-cell lymphoma of the Waldeyer’s ring in the rituximab era

目的分析在美罗华联合化疗背景下,放疗对局限期韦氏环弥漫大B细胞淋巴瘤的治疗价值。方法收集2010年—2017年收治的93例Ⅰ-Ⅱ期原发韦氏环弥漫大B细胞淋巴瘤患者的临床资料,将仅接受美罗华联合CHOP或CHOP类似方案化疗的38例患者分为单纯化疗组,将接受化疗+巩固放疗的55例患者分为综合治疗组。采用Kaplan-Meier法计算无进展生存(PFS)、总生存(OS)、局部区域控制率(LRC),并行单因素分析;采用Logrank法检验两组患者生存差异,并行Cox多因素回归分析。结果本研究患者随访中位时间47个月,3年存活病例67例。单纯化疗组和综合治疗组患者的3年PFS分别为76.1%和94.2%(P=0.036),3年OS分别为78.6%和96.0%(P=0.032),3年LRC分别为83.1%和98.1%(P=0.015)。其中62例化疗后疗效评估为完全缓解(CR)的患者中,单纯化疗组和综合治疗组的3年PFS、OS和LRC分别为87.8%和97.6%(P=0.164)、93.8%和97.4%(P=0.522)、87.8%和100.0%(P=0.028)。进一步单因素分析结果显示,年龄>60岁和化疗疗效未达CR是PFS和OS的不良预后因素,B症状和化疗疗效未达CR是LRC的不良预后因素。多因素分析结果显示,年龄>60岁、B症状、化疗疗效未达CR是患者PFS的不良预后因素,年龄>60岁、化疗疗效未达CR是OS的不良预后因素,B症状、化疗疗效未达CR和未放疗是LRC的不良预后因素。结论Ⅰ-Ⅱ期原发韦氏环弥漫大B细胞淋巴瘤采用美罗华联合CHOP为主的化疗后的巩固性放疗可显著改善患者的PFS、OS和LRC,但仍需大样本和前瞻性研究进一步证实。

Objective To analyze the value of radiotherapy in limited-stage primary diffuse large B-cell lymphoma of Waldeyer′s ring(WR-DLBCL)in the rituximab era.Methods A retrospective study of 93 patients with stageⅠ-Ⅱprimary WR-DLBCL was carried out from 2010 to 2017.Totally,38 patients who underwent rituximab+CHOP(R-CHOP)or RCHOP-like chemotherapy were taken into the chemotherapy alone group,while 55 patients who underwent R-CHOP/R-CHOPlike chemotherapy plus consolidation radiotherapy were taken into the combined treatment group.Kaplan-Meier method was used to calculate the progression-free survival(PFS),overall survival(OS)and locoregional control(LRC),and univariate analysis was performed.Log-rank method was used to test the survival difference between the two groups,and Cox multivariate regression analysis was performed.Results The median follow-up time was 47 months,and 67 cases survived for 3 years.The 3-year PFS,3-year OS and 3-year LRC of the chemotherapy alone group and combined treatment group were respectively 76.1%vs.94.2%(P=0.036),78.6%vs.96.0%(P=0.032),and 83.1%vs.98.1%(P=0.015).After chemotherapy,62 patients achieved complete response(CR).For them,the 3-year PFS,3-year OS and 3-year LRC were respectively 87.8%vs.97.6%(P=0.164),93.8%vs.97.4%(P=0.522),and 87.8%vs.100.0%(P=0.028)in the chemotherapy alone group and the combined treatment group.Univariate prognostic analysis showed that the age>60 years and chemotherapy efficacy below CR(non-CR)were adverse prognostic factors for PFS and OS,while B symptoms and non-CR were adverse prognostic factors for LRC.Multivariate prognostic analysis showed that the age>60 years,B symptoms and non-CR were poor prognostic factors for PFS,while the age>60 years and non-CR were poor prognostic factors for OS,while B symptoms,non-CR and no radiotherapy were poor prognostic factors for LRC.Conclusion R-CHOP/R-CHOP-like chemotherapy plus consolidation radiotherapy could improve the PFS,OS and LRC of patients with limited-stage primary diffuse large B-cell lymphoma of Waldeyer′s ring.This conclusion still needs large samples and prospective studies to confirm.