Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China.
Department of Colorectal Surgery and State Key Lab of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Asia Pac J Clin Oncol. 2020 Dec;16(6):385-391. doi: 10.1111/ajco.13396. Epub 2020 Aug 10.
The aim of the study was to compare the therapeutic strategies and prognostic factors of patients with primary intestinal diffuse large B-cell lymphoma (PI-DLBCL).
A total of 50 PI-DLBCL patients who accepted standard first-line treatment at National Cancer Center in China were included in this retrospective study. Survival analysis was performed to evaluate the prognostic risk factors.
The 3-year overall survival (OS) and 3-year progression-free survival (PFS) for the entire group were 76.0% and 65.9%, respectively. Univariate analysis showed that B symptom, advanced Lugano stage, elevated LDH status, poor ECOG PS and immunochemotherapy alone were significantly correlated with a poor PFS. Elevated LDH status, poor ECOG PS, advanced Lugano stage, high IPI score and immunochemotherapy alone were significantly correlated with a poor OS. Multivariate analysis revealed that ECOG PS (P= 0.035; HR = 0.233; 95% CI, 0.060-0.905), LDH level (P = 0.010; HR = 0.223; 95% CI, 0.072-0.693) and surgery (P = 0.002; HR = 5.584; 95% CI, 1.883-16.563) were independent prognostic factors for OS. LDH level (P = 0.035; HR = 0.210; 95% CI, 0.049-0.894) and surgery (P = 0.003; HR = 6.410; 95% CI, 1.903-21.593) were independent risk factors for PFS in PI-DLBCL. R-CHOP immunochemotherapy combined surgery treatment was also associated with a lower rate of refractory/relapsed (R/R) disease (P = 0.004). Furthermore, stratified analysis revealed that partial resection or radical resection combined with immunochemotherapy had no significantly difference which affect OS (P = 0.338) and PFS (P = 0.207).
R-CHOP immunochemotherapy plus surgery was associated with a superior prognosis compared with R-CHOP alone in Chinese PI-DLBCL population.
本研究旨在比较原发性肠道弥漫性大 B 细胞淋巴瘤（PI-DLBCL）患者的治疗策略和预后因素。
本回顾性研究纳入了在中国国家癌症中心接受标准一线治疗的 50 例 PI-DLBCL 患者。采用生存分析评估预后风险因素。
全组患者的 3 年总生存率（OS）和 3 年无进展生存率（PFS）分别为 76.0%和 65.9%。单因素分析显示，B 症状、晚期 Lugano 分期、升高的乳酸脱氢酶（LDH）状态、较差的东部肿瘤协作组体力状态（ECOG PS）和单纯免疫化疗与较差的 PFS 显著相关。升高的 LDH 状态、较差的 ECOG PS、晚期 Lugano 分期、较高的国际预后指数（IPI）评分和单纯免疫化疗与较差的 OS 显著相关。多因素分析显示，ECOG PS（P=0.035；HR=0.233；95%CI，0.060-0.905）、LDH 水平（P=0.010；HR=0.223；95%CI，0.072-0.693）和手术（P=0.002；HR=5.584；95%CI，1.883-16.563）是 OS 的独立预后因素。LDH 水平（P=0.035；HR=0.210；95%CI，0.049-0.894）和手术（P=0.003；HR=6.410；95%CI，1.903-21.593）是 PI-DLBCL 患者 PFS 的独立危险因素。R-CHOP 免疫化疗联合手术治疗也与较低的难治/复发（R/R）疾病率相关（P=0.004）。此外，分层分析显示，部分切除术或根治性切除术联合免疫化疗对 OS（P=0.338）和 PFS（P=0.207）无显著影响。
与单纯 R-CHOP 相比，中国 PI-DLBCL 人群中 R-CHOP 免疫化疗加手术治疗具有更好的预后。
