Romaguera J E, McLaughlin P, North L, Dixon D, Silvermintz K B, Garnsey L A, Velasquez W S, Hagemeister F B, Cabanillas F
Department of Hematology, University of Texas MD Anderson Cancer Center, Houston 77030.
J Clin Oncol. 1991 May;9(5):762-9. doi: 10.1200/JCO.1991.9.5.762.
We analyzed the records of 96 previously untreated patients with stage IV follicular low-grade lymphoma (FLGL) uniformly treated with cyclophosphamide, doxorubicin, vincristine, prednisone, and bleomycin (CHOP-Bleo) chemotherapy from 1972 to 1982. The overall complete remission (CR) rate was 77%. At a median follow-up of 138 months, the 10-year cause-specific survival rate was 42% with a median survival of 100 months. Failure-free survival (FFS) was 15% at 10 years with a median FFS of 30 months. Multivariate analysis showed peripheral lymph node size (LN), degree of marrow involvement, and sex, in that order, to be important for FFS, while the number of extranodal sites (#ENS), LN, sex, and degree of marrow involvement were important for cause-specific survival. We devised a tumor burden (TB) model, incorporating #ENS, LN, and degree of marrow involvement. Three groups were identified with statistically significant differences in cause-specific survival and FFS. Those with low TB (one ENS exclusive of extensive marrow and nodal disease less than 5 cm) had a 10-year cause-specific survival of 73% compared with 24% for patients with high TB (greater than or equal to two ENS and nodal disease greater than or equal to 5 cm) (P less than .001) and 40% for those with intermediate TB (either greater than or equal to 2 ENS, or extensive marrow only, or nodal disease greater than 5 cm) (P = .050). Patients with low TB had a 10-year FFS rate of 32%, while the intermediate and high TB groups had 10% and 9% FFS, respectively (P = .003). Because sex was a very strong prognostic variable, we created a risk model for survival and FFS based on TB and sex. Females with low TB had the best prognosis (92% survival and 50% FFS at 10 years) and males with high TB had the worst outlook (median survival and FFS, 43 and 12 months, respectively). Other TB-sex combinations defined two groups with statistically significant differences in survival but comparable FFS. This model should aid in the design and analysis of future trials.
我们分析了1972年至1982年间96例未经治疗的IV期滤泡性低度淋巴瘤（FLGL）患者的记录，这些患者均接受了环磷酰胺、阿霉素、长春新碱、泼尼松和博来霉素（CHOP-Bleo）化疗。总体完全缓解（CR）率为77%。在中位随访138个月时，10年病因特异性生存率为42%，中位生存期为100个月。10年无失败生存率（FFS）为15%，中位FFS为30个月。多因素分析显示，外周淋巴结大小（LN）、骨髓受累程度和性别依次对FFS很重要，而结外部位数量（#ENS）、LN、性别和骨髓受累程度对病因特异性生存很重要。我们设计了一个肿瘤负荷（TB）模型，纳入了#ENS、LN和骨髓受累程度。确定了三组，其病因特异性生存和FFS有统计学显著差异。低TB组（一个结外部位，不包括广泛的骨髓和淋巴结疾病且小于5 cm）的10年病因特异性生存率为73%，而高TB组（大于或等于两个结外部位且淋巴结疾病大于或等于5 cm）为24%（P<0.001），中TB组（大于或等于2个结外部位，或仅广泛骨髓受累，或淋巴结疾病大于5 cm）为40%（P = 0.050）。低TB组患者的10年FFS率为32%，而中TB组和高TB组的FFS分别为10%和9%（P = 0.003）。由于性别是一个非常强的预后变量，我们基于TB和性别创建了生存和FFS风险模型。低TB的女性预后最佳（10年生存率为92%，FFS为50%），高TB的男性预后最差（中位生存期和FFS分别为43个月和12个月）。其他TB-性别组合定义了两组，其生存有统计学显著差异，但FFS相当。该模型应有助于未来试验的设计和分析。
