Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado.
Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado.
Int J Radiat Oncol Biol Phys. 2016 Jan 1;94(1):126-132. doi: 10.1016/j.ijrobp.2015.09.017. Epub 2015 Sep 25.
Primary mediastinal B cell lymphoma (PMBCL) is an uncommon lymphoma for which trials are few with small patient numbers. The role of radiation therapy (RT) after standard immunochemotherapy for early-stage disease has never been studied prospectively. We used the Surveillance, Epidemiology, and End Results (SEER) database to evaluate PMBCL and the impact of RT on outcomes.
We queried the SEER database for patients with stage I-II PMBCL diagnosed from 2001 to 2011. Retrievable data included age, gender, race (white/nonwhite), stage, extranodal disease, year of diagnosis, and use of RT as a component of definitive therapy. Kaplan-Meier overall survival (OS) estimates, univariate (UVA) log-rank and multivariate (MVA) Cox proportional hazards regression analyses were performed.
Two hundred fifty patients with stage I-II disease were identified, with a median follow-up time of 39 months (range, 3-125 months). The median age was 36 years (range, 18-89 years); 61% were female; 76% were white; 45% had stage I disease, 60% had extranodal disease, and 55% were given RT. The 5-year OS for the entire cohort was 86%. On UVA, OS was improved with RT (hazard ratio [HR] 0.446, P=.029) and decreased in association with nonwhite race (HR 2.70, P=.006). The 5-year OS was 79% (no RT) and 90% (RT). On MVA, white race and RT remained significantly associated with improved OS (P=.007 and .018, respectively). The use of RT decreased over time: 61% for the 67 patients whose disease was diagnosed from 2001 to 2005 and 53% in the 138 patients treated from 2006 to 2010.
This retrospective population-based analysis is the largest PMBCL dataset to date and demonstrates a significant survival benefit associated with RT. Nearly half of patients treated in the United States do not receive RT, and its use appears to be declining. In the absence of phase 3 data, the use of RT should be strongly considered for its survival benefit in early-stage disease.
原发性纵隔 B 细胞淋巴瘤（PMBCL）是一种罕见的淋巴瘤，临床试验数量较少，患者人数也较少。对于早期疾病，放射治疗（RT）在标准免疫化疗后的作用从未进行过前瞻性研究。我们使用监测、流行病学和最终结果（SEER）数据库评估 PMBCL 以及 RT 对结局的影响。
我们从 2001 年至 2011 年期间在 SEER 数据库中查询了诊断为 I 期-II 期 PMBCL 的患者。可检索的数据包括年龄、性别、种族（白种人/非白种人）、分期、结外疾病、诊断年份以及 RT 是否作为确定性治疗的一部分。进行了 Kaplan-Meier 总生存（OS）估计、单变量（UVA）对数秩和多变量（MVA）Cox 比例风险回归分析。
共确定了 250 例 I 期-II 期疾病患者，中位随访时间为 39 个月（范围，3-125 个月）。中位年龄为 36 岁（范围，18-89 岁）；61%为女性；76%为白种人；45%为 I 期疾病，60%为结外疾病，55%接受了 RT。整个队列的 5 年 OS 为 86%。在 UVA 中，OS 随着 RT 的使用而改善（风险比 [HR]0.446，P=.029），与非白种人种族相关的 OS 降低（HR2.70，P=.006）。5 年 OS 为 79%（无 RT）和 90%（RT）。在 MVA 中，白种人种族和 RT 仍然与改善的 OS 显著相关（P=.007 和.018）。RT 的使用随着时间的推移而减少：61%用于 2001 年至 2005 年期间诊断的 67 例患者，而 2006 年至 2010 年期间治疗的 138 例患者中，53%使用 RT。
这是一项回顾性基于人群的分析，是迄今为止最大的 PMBCL 数据集，表明 RT 与生存获益显著相关。在美国接受治疗的近一半患者未接受 RT，而且其使用似乎正在减少。在没有 3 期数据的情况下，应该强烈考虑 RT 在早期疾病中的生存获益。
