Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
Memorial Sloan-Kettering Cancer Center, New York.
Ann Oncol. 2017 Sep 1;28(9):2185-2190. doi: 10.1093/annonc/mdx334.
Mantle cell lymphoma (MCL) rarely presents as early-stage disease, but clinical observations suggest that patients who present with early-stage disease may have better outcomes than those with advanced-stage disease.
In this 13-institution study, we examined outcomes among 179 patients with early-stage (stage I or II) MCL in an attempt to identify prognostic factors that influence treatment selection and outcome. Variables examined included clinical characteristics, treatment modality, response to therapy, sites of failure, and survival.
Patients were predominantly male (78%) with head and neck being the most common presenting sites (75%). Most failures occurred outside the original disease site (79%). Although the administration of radiation therapy, either alone or with chemotherapy, reduced the risk of local failure, it did not translate into an improved freedom from progression or overall survival (OS). The treatment outcomes were independent of treatment modality. The 10-year OS for patients treated with chemotherapy alone, chemo-radiation therapy and radiation therapy alone were 69%, 62%, and 74% (P = 0.79), and the 10-year freedom from progression were 46%, 43%, and 31% (P = 0.64), respectively.
Given the excellent OS rates regardless of initial therapy in patients with early-stage MCL, de-intensified therapy to limit treatment-related toxicity is a reasonable approach.
套细胞淋巴瘤（MCL）很少表现为早期疾病，但临床观察表明，早期发病的患者可能比晚期发病的患者预后更好。
在这项由 13 个机构参与的研究中，我们研究了 179 例早期（I 期或 II 期）MCL 患者的结果，试图确定影响治疗选择和结果的预后因素。检查的变量包括临床特征、治疗方式、对治疗的反应、失败部位和生存情况。
患者主要为男性（78%），头颈部是最常见的首发部位（75%）。大多数失败发生在原发病灶以外（79%）。虽然放射治疗的应用，无论是单独应用还是与化疗联合应用，都降低了局部失败的风险，但这并没有转化为无进展生存或总生存的改善（OS）。治疗结果与治疗方式无关。单独接受化疗、化疗联合放疗和单纯放疗的患者 10 年 OS 分别为 69%、62%和 74%（P=0.79），10 年无进展生存率分别为 46%、43%和 31%（P=0.64）。
鉴于早期 MCL 患者无论初始治疗如何，OS 率均很高，因此减少治疗相关毒性的减量化疗是一种合理的方法。
