初发复发尤文肉瘤患者采用大剂量化疗的价值。
The value of high-dose chemotherapy in patients with first relapsed Ewing sarcoma.
机构信息
Department of Pediatric Hematology and Oncology, University Hospital Münster, Westfalian Wilhelms University Münster, Munster, Germany.
出版信息
Pediatr Blood Cancer. 2014 Aug;61(8):1382-6. doi: 10.1002/pbc.25042. Epub 2014 Apr 11.
BACKGROUND
Prognosis of patients with relapsed Ewing sarcoma (ES) is poor. The 5-year overall survival (OS) is 13%. We analyzed high-dose chemotherapy (HDtx) versus conventional chemotherapy (CHtx) in patients with relapsed ES.
PROCEDURE
Data from 239 patients with first relapse, registered during 2000-2011 in the ES relapse registry of the Cooperative Ewing Sarcoma Study Group (CESS) were analyzed.
RESULTS
Of 239 patients, 200 received various non-HDtx second-line CHtx regimens. Seventy-three patients had additional HDtx followed by autologous stem cell rescue. The 2-year event-free survival (EFS) was 10% (SE = 0.02) in patients treated without HDtx and 45% (SE = 0.09) in patients treated with HDtx. In a second step, we focused on those patients who achieved complete remission (CR) or partial remission (PR) after four to six cycles of conventional second-line CHtx. Here, the 2-year EFS was 31% (SE = 0.08) without additional HDtx and 44% (SE = 0.09) with additional HDtx. In addition, multivariate regression analysis indicates absence of HDtx treatment, with a Hazard ratio (HR) of 2.90 (95% CI 1.41-6.0), and early relapse, with a HR of 4.76 (95% CI 2.31-9.78), as independent prognostic factors for EFS.
CONCLUSION
Additional HDtx may contribute to further reduce the risk of further events in patients who respond to conventional second-line CHtx.
背景
复发性尤因肉瘤（Ewing sarcoma，ES）患者的预后较差，5 年总生存率（overall survival，OS）为 13%。我们分析了复发性 ES 患者接受高剂量化疗（high-dose chemotherapy，HDtx）与常规化疗（conventional chemotherapy，CHtx）的疗效。
方法
对 2000 年至 2011 年协作尤因肉瘤研究组（Cooperative Ewing Sarcoma Study Group，CESS）复发登记处登记的 239 例首次复发患者的数据进行了分析。
结果
在 239 例患者中，200 例接受了各种非 HDtx 的二线 CHtx 方案。73 例患者接受了额外的 HDtx 联合自体干细胞解救。未接受 HDtx 治疗的患者 2 年无事件生存率（event-free survival，EFS）为 10%（标准误 [SE] = 0.02），接受 HDtx 治疗的患者为 45%（SE = 0.09）。在第二步中，我们专注于那些在接受四到六个周期的常规二线 CHtx 后达到完全缓解（complete remission，CR）或部分缓解（partial remission，PR）的患者。在此，未接受额外 HDtx 治疗的患者 2 年 EFS 为 31%（SE = 0.08），接受额外 HDtx 治疗的患者为 44%（SE = 0.09）。此外，多变量回归分析表明，未接受 HDtx 治疗的患者复发风险增加 2.90 倍（95%CI 1.41-6.0），早期复发的患者复发风险增加 4.76 倍（95%CI 2.31-9.78），是 EFS 的独立预后因素。
结论
对于对常规二线 CHtx 有反应的患者，额外的 HDtx 可能有助于进一步降低再次发生事件的风险。
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