序贯化疗/放疗与同期放化疗在Ⅰ/Ⅱ期 NK/T 细胞淋巴瘤中疗效相当。
Sequential chemotherapy/radiotherapy was comparable with concurrent chemoradiotherapy for stage I/II NK/T-cell lymphoma.
机构信息
Department of Medicine, Queen Mary Hospital, Hong Kong, China.
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
出版信息
Ann Oncol. 2018 Jan 1;29(1):256-263. doi: 10.1093/annonc/mdx684.
BACKGROUND
In stage I/II natural killer (NK)/T-cell lymphoma, concurrent chemoradiotherapy (CCRT) had previously been shown to result in superior outcome compared with anthracycline-containing regimens, which have since been considered ineffective. The role of CCRT in comparison with approaches employing nonanthracycline-containing chemotherapy (CT) and sequential radiotherapy (RT) in such patients remains to be defined.
PATIENTS AND METHODS
Three hundred and three untreated patients (207 men, 96 women; median age: 51, 18-86 years) with stage I/II NK/T-cell lymphoma who had received nonanthracycline-containing regimens were collected from an international consortium and retrospectively analyzed. Treatment included single modality (CT and RT), sequential modalities (CT + RT; RT + CT) and concurrent modalities (CCRT; CCRT + CT). The impact of clinicopathologic parameters and types of treatment on complete response (CR) rate, progression-free-survival (PFS) and overall-survival (OS) was evaluated.
RESULTS
For CR, stage (P = 0.027), prognostic index for NK/T-cell lymphoma (PINK) (P = 0.026) and types of initial treatment (P = 0.011) were significant prognostic factors on multivariate analysis. On Cox regression analysis, ECOG performance score (P = 0.021) and PINK-EBV DNA (PINK-E) (P = 0.002) significantly impacted on PFS; whereas ECOG performance score (P = 0.008) and stage (P < 0.001) significantly impacted on OS. For comparing CCRT ± CT and sequential CT + RT, CCRT ± CT patients (n = 190) were similar to sequential CT + RT patients (n = 54) in all evaluated clinicopathologic parameters except two significantly superior features (higher proportion of undetectable circulating EBV DNA on diagnosis and lower PINK-E scores). Despite more favorable pre-treatment characteristics, CCRT ± CT patients had CR rate, PFS and OS comparable with sequential CT + RT patients on multivariate and Cox regression analyses.
CONCLUSIONS
In stage I/II NK/T-cell lymphomas, when effective chemotherapeutic regimens were used, CCRT and sequential CT + RT gave similar outcome.
背景
在 I/II 期自然杀伤 (NK)/T 细胞淋巴瘤中，与包含蒽环类药物的方案相比，同期放化疗 (CCRT) 已显示出更好的疗效，后者被认为无效。在这些患者中，CCRT 与采用不含蒽环类药物的化疗 (CT) 和序贯放疗 (RT) 的方法相比的作用仍有待确定。
方法
从一个国际联盟中收集了 303 名未经治疗的 I/II 期 NK/T 细胞淋巴瘤患者（207 名男性，96 名女性；中位年龄：51 岁，18-86 岁），这些患者接受了不含蒽环类药物的方案治疗。治疗包括单一方式（CT 和 RT）、序贯方式（CT+RT；RT+CT）和同期方式（CCRT；CCRT+CT）。评估了临床病理参数和治疗类型对完全缓解（CR）率、无进展生存期（PFS）和总生存期（OS）的影响。
结果
在多变量分析中，CR 的影响因素包括分期（P=0.027）、NK/T 细胞淋巴瘤预后指数（PINK）（P=0.026）和初始治疗类型（P=0.011）。在 Cox 回归分析中，ECOG 表现评分（P=0.021）和 PINK-EBV DNA（PINK-E）（P=0.002）显著影响 PFS；而 ECOG 表现评分（P=0.008）和分期（P<0.001）显著影响 OS。对于比较 CCRT±CT 和序贯 CT+RT，CCRT±CT 组（n=190）与序贯 CT+RT 组（n=54）在所有评估的临床病理参数中相似，除了两个明显的优势特征（更高比例的诊断时可检测到的循环 EBV DNA 和更低的 PINK-E 评分）。尽管 CCRT±CT 组患者具有更有利的治疗前特征，但多变量和 Cox 回归分析显示，CR 率、PFS 和 OS 与序贯 CT+RT 组患者相当。
结论
在 I/II 期 NK/T 细胞淋巴瘤中，当使用有效的化疗方案时，CCRT 和序贯 CT+RT 的疗效相似。
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