Mok T S, Steinberg J, Chan A T, Yeo W M, Hui P, Leung T W, Johnson P
Department of Clinical Oncology, The Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, New Territories.
Cancer. 1998 Jun 15;82(12):2439-48. doi: 10.1002/(sici)1097-0142(19980615)82:12<2439::aid-cncr19>3.0.co;2-q.
Chemotherapy containing anthracycline is the standard initial treatment for aggressive non-Hodgkin's lymphoma (NHL), and the International Prognostic Index (IPI) is widely accepted as the standard tool for determining the prognosis of patients with this disease. However, the data on which the IPI was based primarily came from studies conducted in Western countries. It may not be directly applicable to Asian populations, in which the incidence of primary extranodal lymphoma (PENL) is known to be high.
The authors conducted a retrospective study of 218 patients with aggressive NHL who were treated with chemotherapy. They analyzed the distribution of stage and pathology, prognostic factors, toxicity, and treatment outcome. The IPI was then applied and its ability to identify distinct prognostic groups tested.
Eighty-six patients (39.4%) had lymph node lymphoma (LNL) and 132 (60.6%) had primary extranodal lymphoma (defined as non-Hodgkin's lymphoma with primary presentation, bulk of disease, and histologic confirmation at an extranodal site). The most common primary extranodal sites were the stomach (22%) and Waldeyer's tonsillar ring (18.9%). The complete response rate of PENL patients to chemotherapy containing anthracycline was 52%, as compared with 64% of the LNL group. The 5-year survival rates for patients with LNL and PENL were 57.4% and 52.1%, respectively. The toxicity in the two patient groups was similar. Four of the prognostic factors in the IPI-age, serum LDH, performance status, and disease stage-predicted significantly different survival for PENL and LNL patients. However, the number of extranodal sites involved was not a significant predictive variable in PENL.
The IPI was applicable to this Chinese population in which the incidence of PENL was high, although the number of extranodal sites did not achieve statistical significance as a risk factor. A proposal for modification was made. Chemotherapy containing anthracycline was an effective treatment for both PENL and LNL patients.
含蒽环类药物的化疗是侵袭性非霍奇金淋巴瘤（NHL）的标准初始治疗方法，国际预后指数（IPI）被广泛接受为确定该疾病患者预后的标准工具。然而，IPI所依据的数据主要来自西方国家开展的研究。它可能不适用于亚洲人群，因为已知亚洲人群中原发结外淋巴瘤（PENL）的发病率较高。
作者对218例接受化疗的侵袭性NHL患者进行了一项回顾性研究。他们分析了分期和病理分布、预后因素、毒性及治疗结果。然后应用IPI并测试其识别不同预后组的能力。
86例患者（39.4%）患有淋巴结淋巴瘤（LNL），132例（60.6%）患有原发结外淋巴瘤（定义为以结外部位为首发表现、疾病主体及组织学证实的非霍奇金淋巴瘤）。最常见的原发结外部位是胃（22%）和瓦尔代尔扁桃体环（18.9%）。PENL患者对含蒽环类药物化疗的完全缓解率为52%，而LNL组为64%。LNL和PENL患者的5年生存率分别为57.4%和52.1%。两组患者的毒性相似。IPI中的四个预后因素——年龄、血清乳酸脱氢酶、体能状态和疾病分期——对PENL和LNL患者的生存预测有显著差异。然而，受累结外部位的数量在PENL中不是一个显著的预测变量。
IPI适用于这个PENL发病率较高的中国人群，尽管结外部位数量作为危险因素未达到统计学意义。提出了修改建议。含蒽环类药物的化疗对PENL和LNL患者均为有效治疗方法。
