Ⅰ/Ⅱ期韦氏环弥漫大B细胞淋巴瘤免疫化疗后放疗疗效观察

Efficacy of radiotherapy after immunochemotherapy in patients with stageⅠ/Ⅱdiffuse large B-cell lymphoma of Waldeyer's ring

目的评价免疫化疗后早期韦氏环弥漫大B细胞淋巴瘤(DLBCL)的预后因素及放疗价值。方法回顾性分析2009-03-21-2017-05-16本院收治的60例Ⅰ/Ⅱ期韦氏环DLBCL患者临床资料。将患者分为放疗组(33例)和未放疗组(27例),均接受利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松(R-CHOP)方案的免疫化疗,放疗组在免疫化疗后接受累及野放疗(中位剂量:46 Gy)。生存分析采用Kaplan-Meier曲线描述并行log-rank检验,Cox比例风险模型分析影响预后的因素。结果全组随访达5年者有46例,5年总生存(OS)率、无进展生存(PFS)率和局部区域控制(LRC)率分别为80.00%、67.95%和84.47%。单因素分析结果显示,Ann Arbor分期为Ⅱ期、美国东部肿瘤协作组(ECOG)评分≥2分、分期改良国际预后指数(smIPI)评分≥2分和未放疗是OS的预后不良因素,Ann Arbor分期为Ⅱ期、ECOG评分≥2分是PFS的预后不良因素,而放疗则是LRC的有利因素。多因素分析结果显示,与OS有关联的因素包括年龄(HR=3.660,95%CI:1.026~13.053)、Ann Arbor分期(HR=10.249,95%CI:1.633~64.322)和放疗(HR=0.386,95%CI:0.160~0.933);与PFS有关联的因素为Ann Arbor分期(HR=7.343,95%CI:1.702~31.683);与LRC有关联的因素为放疗(HR=0.143,95%CI:0.031~0.667)。免疫治疗后获得部分缓解的患者接受放疗可改善5年LRC率(100.00%vs 57.14%),χ^(2)=5.691,P=0.017。结论早期韦氏环DLBCL免疫化疗后预后良好,放疗可改善免疫化疗后达到部分缓解者的局部控制。

Objective To evaluate the prognostic factors and the benefit of radiotherapy in early diffuse large B-cell lymphoma(DLBCL)of Waldeyer's ring after immunochemotherapy.Methods The medical records of 60patients with stageⅠ/ⅡWaldeyers ring DLBCL treated at our institution from March 21,2009to May 16,2017were retrospectively reviewed.Patients were divided into radiotherapy group(n=33)and non-radiotherapy group(n=27)and all the patients received immunochemotherapy based on rituximab combined with cyclophosphamide,doxorubicin,vincristine,and prednisone(RCHOP).The radiotherapy group received involved field radiotherapy(median dose:46Gy)after immunochemotherapy.Survival analysis was performed by using Kaplan-Meier curves with the log-rank test,and Cox proportional hazards model was used for multivariate analysis of prognostic factors.Results Forty-six patients were followed up for 5years,and the 5-year overall survival(OS)rate,progression-free survival(PFS)rate and locoregional control(LRC)rate for the entire cohort were 80.00%,67.95%and 84.47%,respectively.Univariate analysis indicated that Ann Arbor stageⅡ,Eastern Cooperative Oncology Group(ECOG)score≥2,stage-modified international prognostic index(smIPI)score≥2,and nonradiotherapy were poor prognostic factors for OS,and Ann Arbor stageⅡ,ECOG score≥2were poor prognostic factors for PFS,while radiotherapy was favorable for LRC.Multivariate analysis showed that factors associated with OS included age(HR=3.660,95%CI:1.026-13.053),Ann Arbor stage(HR=10.249,95%CI:1.633-64.322),and radiotherapy(HR=0.386,95%CI:0.160-0.933);factor associated with PFS was Ann Arbor stage(HR=7.343,95%CI:1.702-31.683);and factor associated with LRC was radiotherapy(HR=0.143,95%CI:0.031-0.667).For patients with partial remission after immunotherapy,radiotherapy significantly improved the 5-year LRC rate(100.00%vs 57.14%),χ2=5.691,P=0.017.Conclusions Early WR-DLBCL has a favorable prognosis after immunochemotherapy,and radiotherapy can improve the local control of patients with partial remission after immunochemotherapy.