Studies on the pathology of non‐Hodgkin's lymphoma of childhood: I. The role of routine histopathology as a prognostic factor a report from the childrens cancer study group
Studies on the pathology of non‐Hodgkin's lymphoma of childhood: I. The role of routine histopathology as a prognostic factor a report from the childrens cancer study group
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儿童非霍奇金淋巴瘤的病理学研究：一、常规组织病理学作为预后因素的作用儿童癌症研究组的报告
作者：
MD J. F. WILSON;MB A. D. T. JENKIN;Phd J. R. ANDERSON;M. P. C. M. R. R. CHILCOTE;M. J. K. M. C. R. K. M. IP. R. EXELBY;J. Kushner;MD A. MEADOWS;MD W. W. SHEEHAN;Mdii R Siegel;PHDlI S SPOS'TO;LElKlN MD;MD D. Hammond;Richard O'Brien.;MD Eugene Lahey;MD Martin Klemperer;Mavis Teasdale;A. Evans
1977年4月至1980年8月，儿童癌症研究小组(CCSG)对儿童非霍奇金淋巴瘤(NHL)进行了一项临床试验，将256名患者随机分为两种治疗方案之一。方案1(方案1，改良环磷酰胺、长春新碱、甲氨蝶呤、强的松[COMP])与10方案(方案2，改良LSA2-I2)进行比较。使用RapPaport分类，综述病理学家诊断213例可评估的组织标本如下：淋巴母细胞(LC)73例；Burkitt‘s瘤(BT)40例；“未分化”非Burkitt’s型(NB)67例；大细胞或“组织细胞性”淋巴瘤(HI)29例；以及其他类型(OT)，4.当使用上述四种分类时，综述病理学家与机构病理学家在分类上的一致性很差；然而，综述病理学家与其他血液病理学家之间的符合率为88%，当将标本分类为淋巴母细胞性或非淋巴细胞性时，符合率为99%。对于非局限性疾病的患者，这项随机对照研究显示了组织病理学与治疗效果的新的重要相关性。当不分成淋巴母细胞型和非淋巴母细胞型进行分析时，对于非局限性受累的患者，两种方案显示了相同的无复发生存率(RFS)曲线。然而，当根据组织学分类对患者进行分层时，方案2优于方案1，30个月时方案2的有效率为74%，方案1为31%(P=0.001)。相反，方案1治疗的非淋巴细胞型(BT、NB、HI)患者30个月的RFS为58%，而方案2的RFS为32%(P=0.01)。这项研究表明，对于非局限性受累的儿童，正确的、常规的NHL组织病理学分类是选择治疗的最佳标准。作为这项研究的结果，所有在1980年8月后被诊断为非局限性疾病的患者不再被随机分配，而是根据组织病理学的前瞻性回顾被分配到适当的治疗方案。
Between April 1977, and August 1980, the Childrens Cancer Study Group (CCSG) conducted a clinical trial of childhood non‐Hodgkin's lymphoma (NHL), randomizing 256 patients to one of two treatment regimens. A 4‐drug regimen (regimen 1, modified cyclophosphamide, Oncorin [vincristine], methotrexate, prednisone [COMP]) was compared with a 10‐drug regimen (regimen 2, modified LSA2‐I2). Using the Rappaport classification, the review pathologist diagnosed the 213 evaluable tissue specimens as follows: lymphoblastic (LC), 73; Burkitt's tumor (BT), 40; “undifferentiated” non‐Burkitt's type (NB), 67; large cell or “histiocytic” lymphoma (HI), 29; and other types (OT), 4. Concurrence in classification between the review and institutional pathologists was poor when using the above four categories; however, concurrence was 88% between the review pathologist and other hematopathologists, and 99% when classifying the specimens as lymphoblastic or nonlymphoblastic. For patients with nonlocalized disease, this randomized controlled study demonstrated a new important correlation of histopathology with the effectiveness of treatment. When analyzed without stratification into lymphoblastic and nonlymphoblastic types, the two regimens showed identical relapse free survival (RFS) curves for patients with nonlocalized involvement. However, when patients were stratified according to histologic classification, regimen 2 was superior to regimen 1 for patients with lymphoblastic lymphoma, achieving 74% RFS at 30 months compared to 31% for regimen 1 (P = 0.001). Conversely, those with nonlymphoblastic types (BT, NB, HI) treated with regimen 1 had a 58% RFS at 30 months compared to 32% for those treated on regimen 2 (P = 0.01). This study demonstrates that proper, routine histopathologic classification of NHL is the best criterion for choice of therapy in children with nonlocalized involvement. As a result of this study, all patients with nonlocalized disease, diagnosed after August 1980, were no longer randomized but were assigned to the appropriate treatment regimen based on prospective review of histopathology.