Treatment Strategies and Prognostic Factors of Primary Gastric Diffuse Large B Cell Lymphoma: A Retrospective Multicenter Study of 272 Cases from the China Lymphoma Patient Registry
Treatment Strategies and Prognostic Factors of Primary Gastric Diffuse Large B Cell Lymphoma: A Retrospective Multicenter Study of 272 Cases from the China Lymphoma Patient Registry
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原发性胃弥漫性大B细胞淋巴瘤的治疗策略和预后因素：中国淋巴瘤患者登记中心272例的回顾性多中心研究
DOI：
10.7150/ijms.34175
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发表时间：
2019-01-01
影响因子：
3.6
通讯作者：
Zhu, Jun
中科院分区：
文献类型：
--
作者：
Yang, Haiyan;Wu, Meng;Zhu, Jun
背景：手术、利妥昔单抗和化疗在原发性胃弥漫性大 B 细胞淋巴瘤 (PGDLBCL) 治疗中各自和组合的作用仍不清楚。本研究的目的是评估 PGDLBCL 目前的治疗策略和预后因素。方法：对1994年1月至2015年12年272例病例进行回顾性分析。根据治疗方案，将患者分为四组：化疗（C）、化疗+手术（C+S）、利妥昔单抗+化疗（R+C）、利妥昔单抗+化疗+手术（R+C+S）。结果：整个队列的3年无进展生存率（PFS）和3年总生存率（OS）分别为77.0%和81.2%（中位随访时间：44.3个月）。接受手术治疗的患者的生存率优于仅接受药物治疗的患者的生存率（PFS：82.6% vs. 74.7%，p=0.015；OS：87.8% vs. 78.6%，p=0.036）。利妥昔单抗在 OS 方面表现出显着的临床获益（87.1% vs. 75.0%，p=0.007），特别是在晚期或高风险 (IPI 3-5) 患者中。四组中 C 组的 PFS 和 OS 最低，而其他三组的生存率相似（C 组 vs. C+S 组 vs. R+C 组 vs. R+C+S 组：3 年 PFS：67.2% vs. 81.4% vs. 81.2% vs. 81.8%，p=0.002；3 年 OS：68.4% vs. 85.4% vs. 87.2% 与 88.6%，p<0.001）。多变量分析表明，IPI 和治疗方案对 PFS 和 OS 具有高度预测性。结论：我们的结果表明，化疗与手术相结合，或化疗与利妥昔单抗联合治疗 PGDLBCL 优于其他治疗策略。 IPI 和治疗方案是结果的独立预测因素。未来的前瞻性试验是有必要的。
Background: The respective and combinatorial roles of surgery, Rituximab and chemotherapy in primary gastric diffuse large B cell lymphoma (PGDLBCL) therapy remained unclear. The purpose of the study was to evaluate present treatment strategies and prognostic factors of PGDLBCL. Methods: 272 cases (from 1994-1 to 2015-12) were retrospectively analyzed. According to the therapy regimen, patients were classified into four groups: chemotherapy (C), chemotherapy + surgery (C+S), Rituximab + chemotherapy (R+C), and Rituximab + chemotherapy + surgery (R+C+S). Results: The 3-year progression-free survival (PFS) and 3-year overall survivals (OS) of the entire cohort were 77.0% and 81.2% respectively (median follow-up time: 44.3 months). Survival of surgery-treated patients was superior to the survival of those receiving drug therapy alone (PFS: 82.6% vs. 74.7%, p=0.015; OS: 87.8% vs. 78.6%, p=0.036). Rituximab showed significant clinical benefit in OS (87.1% vs. 75.0%, p=0.007), especially in advanced-stage or high risk (IPI 3-5) patients. Group C had the lowest PFS and OS among the four groups, while the survival of other three groups were similar (Group C vs. Group C+S vs. Group R+C vs. Group R+C+S: 3-year PFS: 67.2% vs. 81.4% vs. 81.2% vs. 81.8%, p=0.002; 3-year OS: 68.4% vs. 85.4% vs. 87.2% vs. 88.6%, p<0.001). Multivariate analysis showed that IPI and therapy regimens were highly predictive for both PFS and OS. Conclusions: Our results suggested that the combinations of chemotherapy and surgery, or chemotherapy and Rituximab, are superior to other treatment strategies for PGDLBCL. IPI and therapy regimens are independent predictors of outcomes. Future prospective trial is warranted.