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★

摘要:

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Log-rank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。

Abstract:

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 stage Ⅰ-Ⅱ primary WR-DLBCL was carried out from 2010 to 2017. Totally, 38 patients who underwent rituximab + CHOP (R-CHOP) or R-CHOP-like chemotherapy were taken into the chemotherapy alone group, while 55 patients who underwent R-CHOP/R-CHOP-like 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.