Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China.
Department of Health Management, Renmin Hospital of Wuhan University, Wuhan, China.
Cancer Med. 2021 Jan;10(2):540-551. doi: 10.1002/cam4.3620. Epub 2020 Nov 28.
The stage-specific roles of radiotherapy (RT) alone, chemotherapy alone, and combined RT and chemotherapy (CRT) for patients with nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) have not been adequately evaluated.
We analyzed patients with all stages of NLPHL enrolled in the Surveillance, Epidemiology, and End Results (SEER) registry from January 2000 to December 2015. Propensity score (PS) analysis with 1:1 matching (PSM) was performed to ensure the well-balanced characteristics of the comparison groups. Kaplan-Meier and Cox proportional-hazards models were used to evaluate the overall survival (OS), cancer-specific survival (CSS), hazard ratios (HRs), and corresponding 95% confidence intervals (95% CI). Restricted mean survival times (RMST) were also used for the survival analyses.
For early-stage patients, CRT was associated with the best survival, the mean OS was significantly improved by approximately 20 months (20 m), and the risk of death was reduced by more than 80%, both before and after PSM (p < 0.05). For advanced-stage patients, none of RT alone, chemotherapy alone, or CRT had a significant effect on survival. Chemotherapy alone and CRT might be more beneficial for long-term survival (RMST : neither RT nor chemotherapy vs. chemotherapy alone vs. CRT = 104 m vs. 111 m vs. 108 m). Subgroup analysis of patients with early-stage NLPHL showed that CRT was associated with better survival of elderly patients (improved OS = 43.8 m, HR = 0.14, p < 0.05). However, the survival benefits of treatments for young patients were not statistically significant. The efficacy of RT was significantly different between the age groups (p = 0.020).
These results from SEER data suggest that CRT may be considered for early-stage NLPHL, especially for elderly patients. Further studies are needed to identify effective treatments in patients with advanced-stage NLPHL.
结节性淋巴细胞为主型霍奇金淋巴瘤（NLPHL）患者单独接受放疗（RT）、单独接受化疗和联合 RT 与化疗（CRT）的各期别作用尚未得到充分评估。
我们分析了 2000 年 1 月至 2015 年 12 月期间参加监测、流行病学和最终结果（SEER）登记处的所有分期 NLPHL 患者。采用倾向评分（PS）分析 1:1 匹配（PSM）以确保比较组的特征均衡。采用 Kaplan-Meier 和 Cox 比例风险模型评估总生存期（OS）、癌症特异性生存期（CSS）、风险比（HR）及其相应的 95%置信区间（95%CI）。也采用受限平均生存时间（RMST）进行生存分析。
对于早期患者，CRT 治疗的生存获益最佳，PSM 前后 OS 均显著改善约 20 个月（20m），死亡风险降低 80%以上（均 P<0.05）。对于晚期患者，单独使用 RT、单独使用化疗或 CRT 对生存均无显著影响。单独使用化疗和 CRT 可能对长期生存更有益（RMST：均无 RT 或化疗 vs. 单独化疗 vs. CRT=104m vs. 111m vs. 108m）。早期 NLPHL 患者的亚组分析显示，CRT 与老年患者的更好生存相关（OS 改善=43.8m，HR=0.14，P<0.05）。然而，年轻患者的治疗生存获益没有统计学意义。RT 的疗效在不同年龄组之间存在显著差异（p=0.020）。
这些来自 SEER 数据的结果表明，CRT 可考虑用于早期 NLPHL，特别是老年患者。需要进一步研究以确定晚期 NLPHL 患者的有效治疗方法。
