Increase in survival for patients with mantle cell lymphoma in the era of novel agents in 1995-2013: Findings from Texas and national SEER areas
Increase in survival for patients with mantle cell lymphoma in the era of novel agents in 1995-2013: Findings from Texas and national SEER areas
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DOI：
10.1016/j.canep.2018.12.002
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发表时间：
2019-02-01
影响因子：
2.6
通讯作者：
Du, Xianglin L.
中科院分区：
文献类型：
--
作者：
Fu, Shuangshuang;Wang, Michael;Du, Xianglin L.
背景：在过去的20年里，许多新的药物和治疗方案已被开发用于治疗套细胞淋巴瘤（MCL）。方法：收集1995 - 2013年美国SEER和TCR数据库中所有新诊断的MCL患者的资料，分析这些新方案对MCL患者生存率的影响。根据新的新药上市的时间，将患者分为4个日历周期：仅化疗（1995-1998，P1）、利妥昔单抗+化疗（1999-2004，P2）、硼替佐米和HyperCVAD（2005-2008，P3）、苯达莫司汀和Nordic方案（2009-2013，P4）。使用Kaplan-Meier方法和考克斯比例风险回归分析这些时间段和生存结局之间的关联。从1995年到2013年，全因死亡率显著下降（SEER，P < 0.001; TCR，P = 0.03）。SEER数据的多变量分析显示，在研究期间，MCL特异性死亡的风险显著降低，风险比为0.82（P2 vs. P1）、0.66（P3 vs. P1）和0.58（P4 vs. P1）（P < 0.0001）。TCR数据也观察到类似的结果（P < 0.0001）。在一项按肿瘤分期分层的分析中，只有晚期肿瘤患者的死亡风险在两项SEER中均显著降低，（P < 0.0001）和TCR（P = 0.002）数据集。从1995年到2013年，MCL患者的生存结局有所改善，尤其是晚期肿瘤患者，潜在地反映了新药和新治疗方案引入的影响。
Background: Over the past 20 years, many novel agents and treatment regimens have been developed to treat mantle cell lymphoma (MCL). This study aimed to determine the impact of these new regimens on the survival of MCL patients from 1995 to 2013.Methods: All newly diagnosed adult MCL patients in the Surveillance, Epidemiology, and End Results (SEER) and Texas Cancer Registry (TCR) databases were included. Patients were grouped into 4 calendar periods based on the time when new novel agents became available: chemotherapy-only (1995-1998, P1), rituximab + chemotherapy (1999-2004, P2), bortezomib and HyperCVAD (2005-2008, P3), bendamustine and Nordic regimen (2009-2013, P4). Associations between these time periods and survival outcomes were analyzed using the Kaplan-Meier method and Cox proportional hazard regressions.Results: A total of 7,555 SEER patients and 2,055 TCR patients were identified. All-cause mortality rates decreased significantly from 1995 to 2013 (SEER, P < 0.001; TCR, P = 0.03). Multivariable analysis of SEER data showed that the risk of MCL-specific death decreased significantly over the study period with hazard ratios of 0.82 (P2 vs. P1), 0.66 (P3 vs. P1), and 0.58 (P4 vs. P1) (P < 0.0001). Similar results were observed for TCR data (P < 0.0001). In an analysis stratified by tumor stage, only patients with advanced-stage tumors showed a significantly decreased risk of death in both SEER (P < 0.0001) and TCR (P = 0.002) datasets.Conclusion: Survival outcome for MCL patients improved from 1995 to 2013, especially for patients with advanced-stage tumors, potentially reflecting the impact of the introduction of novel agents and new therapeutic regimens.