儿童霍奇金淋巴瘤患者的预后和影响因素：单中心经验。
Outcome and prognostic factors of pediatric patients with Hodgkin lymphoma: a single-center experience.
机构信息
Department of Pediatric Oncology and Hematology, National Cancer Institute, Cairo University, Cairo, Egypt.
Department of Pediatric Oncology and Hematology, Children Cancer Hospital Egypt (CCHE -57357), Cairo, Egypt.
出版信息
J Egypt Natl Canc Inst. 2023 Sep 11;35(1):29. doi: 10.1186/s43046-023-00189-w.
BACKGROUND
Hodgkin lymphoma (HL) is a highly curable malignant tumor. Risk-adapted treatment for children with HL aims to maximize survival while minimizing toxicity. The purpose of this study is to evaluate the outcome and prognostic characteristics of Egyptian pediatric HL patients treated at the National Cancer Institute (NCI), Cairo University.
METHODS
All newly diagnosed cases of classic HL treated between January 2016 and December 2018 were included in this study.
RESULTS
The median age at initial presentation was 8 years in 69 eligible individuals, with a male-to-female ratio of 4.7:1. Eighteen percent of patients had an elevated erythrocyte sedimentation rate (ESR) of more than 50, 42% had more than three lymph node (LN) group involvements, 18.8% had bulky disease, 52.2% were at an advanced stage, and 34% had B symptoms. Age > 15 years, B symptoms, > 3 LN group involvement, extra-nodal disease, and advanced stages significantly affected the overall survival rate (OS) (P-values = 0.03, 0.033, 0.008, 0.017, and 0.032). There was no statistically significant difference between patients who got combined modality therapy (CMT) and those who received chemotherapy alone (3-year OS and event-free survival (EFS) were 95.5% and 87.6% vs. 89.9% and 83.3%, P-values of 0.70 and 0.90). Patients with an interim-negative positron emission tomography-computed tomography (PET-CT) had a 3-year OS of 94.7%, compared to 74.1% in patients with an interim-positive PET-CT (P = 0.06), suggesting that rapid early response (RER) is a significant prognostic factor. There was no statistically significant survival difference between patients with a negative interim PET-CT who got CMT and those who received chemotherapy alone (3-year OS and EFS: 100% and 88.2% vs. 95% and 90%; P = 0.35 and 0.70, respectively). Three-year OS was 93.3% and 100%, and EFS was 74.3% and 100% (P = 0.495 and 0.196%) for those who got 15 Gy versus those who received 20 Gy or more, respectively. At the end of the study, the OS and EFS at 3 years for the whole group were 91.9% and 83.6%.
CONCLUSION
Treatment with risk- and response-adaptive treatment should be the standard of care for treating pediatric patients with HL.
背景
霍奇金淋巴瘤（HL）是一种高度可治愈的恶性肿瘤。儿童 HL 的风险适应治疗旨在最大限度地提高生存率，同时将毒性降至最低。本研究的目的是评估在开罗大学国家癌症研究所（NCI）接受治疗的埃及儿科 HL 患者的结果和预后特征。
方法
本研究纳入了 2016 年 1 月至 2018 年 12 月期间新诊断为经典 HL 的所有病例。
结果
69 名符合条件的患者中，中位初诊年龄为 8 岁，男女比例为 4.7:1。18%的患者红细胞沉降率（ESR）超过 50，42%的患者有 3 个以上淋巴结（LN）组受累，18.8%的患者有巨大肿块，52.2%的患者处于晚期，34%的患者有 B 症状。年龄>15 岁、B 症状、>3 个 LN 组受累、结外疾病和晚期显著影响总生存率（OS）（P 值分别为 0.03、0.033、0.008、0.017 和 0.032）。接受联合模式治疗（CMT）和单纯化疗的患者之间 3 年 OS 和无事件生存率（EFS）无统计学差异（3 年 OS 和 EFS 分别为 95.5%和 87.6%与 89.9%和 83.3%，P 值分别为 0.70 和 0.90）。中期阴性正电子发射断层扫描-计算机断层扫描（PET-CT）的患者 3 年 OS 为 94.7%，而中期阳性 PET-CT 的患者为 74.1%（P=0.06），表明快速早期反应（RER）是一个重要的预后因素。中期阴性 PET-CT 的患者接受 CMT 和单纯化疗的 3 年 OS 和 EFS 无统计学差异（3 年 OS 和 EFS 分别为 100%和 88.2%与 95%和 90%；P=0.35 和 0.70）。接受 15 Gy 照射的患者 3 年 OS 和 EFS 分别为 93.3%和 74.3%，而接受 20 Gy 或以上照射的患者分别为 100%和 100%（P=0.495 和 0.196%）。研究结束时，整个组的 3 年 OS 和 EFS 分别为 91.9%和 83.6%。
结论
风险和反应适应性治疗应成为治疗儿科 HL 患者的标准治疗方法。
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