静脉而非鞘内中枢神经系统导向化疗可改善睾丸弥漫性大 B 细胞淋巴瘤患者的生存。
Intravenous but not intrathecal central nervous system-directed chemotherapy improves survival in patients with testicular diffuse large B-cell lymphoma.
机构信息
Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland.
Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
出版信息
Eur J Cancer. 2019 Jul;115:27-36. doi: 10.1016/j.ejca.2019.04.004. Epub 2019 May 10.
BACKGROUND
Testicular lymphoma is a rare malignancy affecting mainly elderly men, the majority representing diffuse large B-cell lymphoma (DLBCL). Its relapse rate is higher than that of nodal DLBCL, often affecting the central nervous system (CNS) with dismal prognosis.
PATIENTS AND METHODS
We searched for patients with testicular DLBCL (T-DLBCL) involvement from the pathology databases of Southern Finland University Hospitals and the Danish Lymphoma Registry. Clinical information was collected, and outcomes between treatment modalities were evaluated. Progression-free survival (PFS), disease-specific survival (DSS) and overall survival (OS) were assessed using Kaplan-Meier and Cox proportional hazards methods.
RESULTS
We identified 235 patients; of whom, 192 were treated with curative anthracycline-based chemotherapy. Full survival data were available for 189 patients. In univariate analysis, intravenous CNS-directed chemotherapy, and irradiation or orchiectomy of the contralateral testis translated into favourable PFS, DSS and OS, particularly among the elderly patients (each p ≤ 0.023). Intrathecal chemotherapy had no impact outcome. In multivariate analyses, the advantage of intravenous CNS-directed chemotherapy (hazard ration [HR] for OS, 0.419; 95% confidence interval [CI], 0.256-0.686; p = 0.001) and prophylactic treatment of contralateral testis (HR for OS, 0.514; 95% CI, 0.338-0.782; p = 0.002) was maintained. Rituximab improved survival only among high-risk patients (International Prognostic Index≥3, p = 0.019). The cumulative risk of CNS progression was 8.4% and did not differ between treatment modalities.
CONCLUSION
The results support the use of CNS-directed chemotherapy and prophylactic treatment of the contralateral testis in patients with T-DLBCL involvement. Survival benefit appears resulting from better control of systemic disease rather than prevention of CNS progression.
背景
睾丸淋巴瘤是一种罕见的恶性肿瘤，主要影响老年男性，大多数为弥漫性大 B 细胞淋巴瘤（DLBCL）。其复发率高于结内 DLBCL，常累及中枢神经系统（CNS），预后较差。
患者和方法
我们从芬兰南部大学医院的病理学数据库和丹麦淋巴瘤登记处搜索了睾丸 DLBCL（T-DLBCL）累及的患者。收集了临床信息，并评估了不同治疗方法的结果。采用 Kaplan-Meier 和 Cox 比例风险方法评估无进展生存期（PFS）、疾病特异性生存期（DSS）和总生存期（OS）。
结果
我们共确定了 235 例患者，其中 192 例接受了以蒽环类药物为基础的治愈性化疗。189 例患者的完整生存数据可用。单因素分析显示，静脉内中枢神经系统定向化疗、同侧睾丸照射或切除术可改善 PFS、DSS 和 OS，特别是在老年患者中（每项 p 值均≤0.023）。鞘内化疗对结果无影响。多因素分析显示，静脉内中枢神经系统定向化疗（OS 的危险比 [HR]，0.419；95%置信区间 [CI]，0.256-0.686；p=0.001）和预防性治疗对侧睾丸（OS 的 HR，0.514；95%CI，0.338-0.782；p=0.002）的优势得以维持。利妥昔单抗仅在高危患者（国际预后指数≥3，p=0.019）中改善生存。CNS 进展的累积风险为 8.4%，不同治疗方法之间无差异。
结论
这些结果支持在 T-DLBCL 累及的患者中使用中枢神经系统定向化疗和预防性治疗对侧睾丸。生存获益似乎源于更好地控制全身疾病，而不是预防 CNS 进展。
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