采用美国协作组方案治疗的青少年和青年霍奇金淋巴瘤患者的结局：一项成人组间（E2496）和儿童肿瘤学组（COG AHOD0031）的对比分析。
Outcomes in adolescents and young adults with Hodgkin lymphoma treated on US cooperative group protocols: An adult intergroup (E2496) and Children's Oncology Group (COG AHOD0031) comparative analysis.
作者信息
Henderson Tara O, Parsons Susan K, Wroblewski Kristen E, Chen Lu, Hong Fangxin, Smith Sonali M, McNeer Jennifer L, Advani Ranjana H, Gascoyne Randy D, Constine Louis S, Horning Sandra, Bartlett Nancy L, Shah Bijal, Connors Joseph M, Leonard John I, Kahl Brad S, Kelly Kara M, Schwartz Cindy L, Li Hongli, Friedberg Jonathan W, Friedman Debra L, Gordon Leo I, Evens Andrew M
机构信息
Department of Pediatrics, University of Chicago, Chicago, Illinois.
Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
出版信息
Cancer. 2018 Jan 1;124(1):136-144. doi: 10.1002/cncr.30979. Epub 2017 Sep 13.
BACKGROUND
There is no clear consensus between pediatric and adult providers about the treatment of adolescents and young adults (AYAs) with Hodgkin lymphoma (HL).
METHODS
Failure-free survival (FFS) and overall survival (OS) were compared between 114 patients ages 17 to 21 years with HL who were treated on the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Intergroup adult E2496 study and 391 similarly patients ages 17 to 21 years with HL who were treated on the pediatric Children's Oncology Group (COG) AHOD0031 study.
RESULTS
Comparing AYAs from the COG and E2496 studies, there were no significant differences in extralymphatic disease, anemia, or hypoalbuminemia. More AYAs in the E2496 trial had stage III and IV disease (63% vs 29%; P < .001) and B symptoms (63% vs 27%; P < .001), and fewer had bulk disease (33% vs 77%; P < .001). More AYAs on the COG trial received radiotherapy (76% vs 66%; P = .03), although in smaller doses. E2496 AYA The 5-year FFS and OS rates were 68% and 89%, respectively in the E2496 AYAs and 81% and 97%, respectively, in the COG AYAs, indicating a statistically superior compared in the COG AYAs (P = .001). In stratified multivariable analyses, E2496 AYAs had worse FFS than COG AYAs in all strata except patients who had stage I and II HL without anemia. Propensity score analysis (based on stage, anemia, and bulk disease) confirmed inferior FFS for E2496 AYAs compared with COG AYAs (P = .004). On the E2496 study, FFS was significantly divergent across age groups (P = .005), with inferior outcomes for those ages 17 to 21 years versus 22-44 years. There was no difference across age on the COG study.
CONCLUSIONS
Younger AYA patients with HL appear to have better outcomes when treated on a pediatric trial than patients of similar age on an adult trial. Prospective studies examining these differences are warranted. Cancer 2018;124:136-44. © 2017 American Cancer Society.
背景
在霍奇金淋巴瘤（HL）青少年和青年（AYA）患者的治疗方面，儿科和成人医疗服务提供者之间尚未达成明确共识。
方法
比较了114例年龄在17至21岁的HL患者（这些患者参与了东部肿瘤协作组 - 美国放射学会影像网络组间成人E2496研究）与391例年龄在17至21岁的类似HL患者（这些患者参与了儿科肿瘤研究组（COG）的AHOD0031研究）的无病生存期（FFS）和总生存期（OS）。
结果
比较COG和E2496研究中的AYA患者，在结外疾病、贫血或低白蛋白血症方面无显著差异。E2496试验中更多的AYA患者患有III期和IV期疾病（63%对29%；P <.001）和B症状（63%对27%；P <.00），而患有大包块疾病的患者较少（33%对77%；P <.001）。COG试验中更多的AYA患者接受了放疗（76%对66%；P =.03），尽管剂量较小。E2496研究中AYA患者的5年FFS率和OS率分别为68%和89%，而COG研究中AYA患者的这两个率分别为81%和97%，表明COG研究中的AYA患者在统计学上更优（P =.001）。在分层多变量分析中，除了患有I期和II期HL且无贫血的患者外，E2496研究中的AYA患者在所有分层中的FFS均比COG研究中的AYA患者差。倾向评分分析（基于分期、贫血和包块疾病）证实E2496研究中的AYA患者的FFS比COG研究中的AYA患者差（P =.004）。在E2496研究中，FFS在不同年龄组之间存在显著差异（P =.005），17至21岁的患者与22 - 44岁的患者相比，预后较差。COG研究中各年龄组之间无差异。
结论
患有HL的年轻AYA患者在儿科试验中接受治疗时，似乎比在成人试验中接受治疗的同龄患者有更好的预后。有必要进行前瞻性研究来探究这些差异。《癌症》2018年；124：136 - 44。©2017美国癌症协会
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