放疗对早期弥漫大B细胞淋巴瘤化疗后CR患者的价值研究

目的 探讨放疗在早期弥漫大B细胞淋巴瘤(DLBCL)化疗后达CR患者中的地位。方法 回顾分析2004—2012年本院治疗的376例Ⅰ、Ⅱ期DLBCL患者资料,均接受至少3个周期CHOP和利妥昔单抗+CHOP方案化疗(R-CHOP)后达CR者。R-CHOP组92例,R-CHOP+放疗组79例,CHOP+放疗组98例,CHOP组107例。放疗为累及野照射30~56 Gy。Kaplan-Meier法计算生存率并Logrank法检验,Cox回归模型多因素预后分析。结果 5年样本量为188例。全组5年DFS、OS分别为80.7%、87.6%,R-CHOP+放疗组和R-CHOP组的分别为94.9%和88.1%(P=0.030)、97.9%和86.0%(P=0.026),CHOP+放疗组和CHOP组的分别为74.2%和71.4%(P=0.623)、87.0%和82.1%(P=0.420)。多因素分析显示吸烟指数<500、IPI<2、加用利妥昔单抗是预后有利因素(P=0.034~0.000)。结论 放疗对早期DLBCL可以提高R-CHOP化疗后CR者的DFS和OS。建议DLBCL使用含利妥昔单抗的化疗,R-CHOP化疗后应接受放疗。希望开展随机对照研究进一步证明该结果。

Clinical value of radiotherapy in early DLBCL patients with complete remission after chemotherapy

Objective To investigate the value of radiotherapy (RT) in patients with early diffuse large B-cell lymphoma (DLBCL) who have achieved a complete remission (CR) after chemotherapy. Methods A retrospective analysis was performed on 376 patients with stage Ⅰ and Ⅱ DLBCL who were admitted to our hospital from 2004 to 2012. All patients achieved a CR after receiving chemotherapy with cyclophosphamide, doxorubicin/epirubicin, vincristine and prednisone (CHOP) or rituximab combined with CHOP (R-CHOP) for at least three cycles. The median age was 53 years. Patients were divided into four groups:R-CHOP group (n=92), R-CHOP+RT group (n=79), CHOP group (n=107), and CHOP+RT group (n= 98). The RT used was involved-field irradiation and the total dose ranged from 30 to 56 Gy. The survival rate was determined using the Kaplan-Meier method, and the survival difference analysis was performed using the log-rank test. Multivariate prognostic analysis was performed using the Cox proportional hazard model. Results The 5-year sample size was 188. The 5-year disease-free survival (DFS) and overall survival (OS) rates in all patients were 80.7% and 87.6%, respectively. The 5-year DFS and OS rates in the R-CHOP+RT group were significantly higher than those in the R-CHOP group (94.9% vs. 88.1%, P=0.030;97.9% vs. 86.0%, P=0.026). No significant differences in DFS and OS rates were observed between the CHOP+RT and CHOP groups (74.2% vs. 71.4%, P=0.623;74.2% vs. 71.4%, P=0.623). Multivariate prognostic analysis revealed that the smoking index<500, international prognostic index<2, and use of rituximab were favorable prognostic factors (P=0.034－0.000). Conclusions Radiotherapy can improve the DFS and OS in early DLBCL patients with CR after R-CHOP chemotherapy. All early stage DLBCL patients are recommended to undergo rituximab-containing chemotherapy followed by radiotherapy. Randomized controlled trials are needed to validate the results.