CAJ | 학술논문

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.
목적 탐토방료재조기미만대B세포림파류(DLBCL)화료후체CR환자중적지위.방법 회고분석2004-2012년본원치료적376례Ⅰ、Ⅱ기DLBCL환자자료,균접수지소3개주기CHOP화리타석단항+CHOP방안화료(R-CHOP)후체CR자.R-CHOP조92례,R-CHOP+방료조79례,CHOP+방료조98례,CHOP조107례.방료위루급야조사30 ～ 56 Gy.Kaplan-Meier법계산생존솔병Logrank법검험,Cox회귀모형다인소예후분석.결과 5년양본량위188례.전조5년DFS、OS분별위80.7％、87.6％,R-CHOP+방료조화R-CHOP조적분별위94.9％화88.1％ (P=0.030)、97.9％화86.0％ (P=0.026),CHOP+방료조화CHOP조적분별위74.2％화71.4％ (P=0.623)、87.0％화82.1％ (P =0.420).다인소분석현시흡연지수＜500、IPI ＜2、가용리타석단항시예후유리인소(P =0.034～0.000).결론 방료대조기DLBCL가이제고R-CHOP화료후CR자적DFS화OS.건의DLBCL사용함리타석단항적화료,R-CHOP화료후응접수방료.희망개전수궤대조연구진일보증명해결과.
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.