早期低级别滤泡淋巴瘤患者接受放疗后生存改善：监测、流行病学和最终结果数据库分析。
Improved survival in patients with early stage low-grade follicular lymphoma treated with radiation: a Surveillance, Epidemiology, and End Results database analysis.
机构信息
Department of Radiation Oncology, University of Colorado Denver Comprehensive Cancer Center, Aurora, Colorado 80045-0508, USA.
出版信息
Cancer. 2010 Aug 15;116(16):3843-51. doi: 10.1002/cncr.25149.
BACKGROUND
External beam radiation therapy (RT) is the standard treatment for stage I-II, grade 1-2 follicular lymphoma. Because of an indolent natural history, some advocate alternative management strategies, including watchful waiting for this disease. The relative improvement in outcomes for patients treated with and without RT has never been tested in randomized trials.
METHODS
The Surveillance, Epidemiology, and End Results database was queried for adult patients with stage I-II, grade 1-2 follicular lymphoma diagnosed from 1973 to 2004. Retrievable patient data included age, sex, race, stage, extranodal disease, and treatment with RT within the first year after diagnosis. Actuarial overall survival (OS) and disease-specific survival (DSS) were analyzed.
RESULTS
A total of 6568 patients were identified. DSS at 5, 10, 15, and 20 years in the RT group was 90%, 79%, 68%, and 63% versus 81%, 66%, 57%, and 51% in the no RT group (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.55-0.68; P<.0001). OS at 5, 10, 15, and 20 years in the RT group was 81%, 62%, 45%, and 35% versus 71%, 48%, 34%, and 23% in patients not receiving RT (HR, 0.68; 95% CI, 0.63-0.73; P<.0001). On multivariate analysis, upfront RT remained independently associated with improved DSS (P<.0001, Cox HR, 0.65; 95% CI, 0.57-0.72) and OS (P<.0001; Cox HR, 0.73; 95% CI, 0.67-0.79). Lymphoma was the most common cause of death (52%). Only 34% of patients received upfront RT.
CONCLUSIONS
Upfront RT was associated with improved DSS and OS compared with alternate management approaches, a benefit that persisted over time. This benefit suggests that watchful waiting with administration of salvage therapies on progression/relapse do not compensate for inadequate initial definitive treatment. Although it is the standard of care for this disease, RT for early stage low-grade follicular lymphoma is greatly underused in the US population; increased use of upfront RT could prevent thousands of deaths from lymphoma in these patients.
背景
对于 I 期-II 期、1-2 级滤泡性淋巴瘤，外照射放射治疗（RT）是标准治疗方法。由于惰性的自然病史，一些人主张采用替代治疗策略，包括对该疾病进行密切观察。对于接受和未接受 RT 治疗的患者，其治疗效果的相对改善从未在随机试验中得到检验。
方法
检索 1973 年至 2004 年间诊断为 I 期-II 期、1-2 级滤泡性淋巴瘤的成年患者的监测、流行病学和最终结果（SEER）数据库。可检索的患者数据包括年龄、性别、种族、分期、结外疾病以及诊断后一年内是否接受 RT 治疗。分析总生存率（OS）和疾病特异性生存率（DSS）。
结果
共纳入 6568 例患者。RT 组的 5 年、10 年、15 年和 20 年 DSS 分别为 90%、79%、68%和 63%，而未接受 RT 组的 5 年、10 年、15 年和 20 年 DSS 分别为 81%、66%、57%和 51%（风险比[HR]，0.61；95%置信区间[CI]，0.55-0.68；P<.0001）。RT 组的 5 年、10 年、15 年和 20 年 OS 分别为 81%、62%、45%和 35%，而未接受 RT 组的 5 年、10 年、15 年和 20 年 OS 分别为 71%、48%、34%和 23%（HR，0.68；95% CI，0.63-0.73；P<.0001）。多变量分析显示，初始 RT 与改善 DSS（P<.0001，Cox HR，0.65；95% CI，0.57-0.72）和 OS（P<.0001；Cox HR，0.73；95% CI，0.67-0.79）独立相关。淋巴瘤是最常见的死亡原因（52%）。只有 34%的患者接受了初始 RT。
结论
与替代治疗方法相比，初始 RT 可改善 DSS 和 OS，且这种益处随时间推移而持续存在。这一益处表明，对进展/复发进行密切观察并给予挽救性治疗，并不能弥补初始确定性治疗的不足。尽管 RT 是该疾病的标准治疗方法，但在美国人群中，早期低级别滤泡性淋巴瘤的 RT 治疗被大大低估；增加初始 RT 的应用可能会预防数千例此类患者的淋巴瘤死亡。
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