Outcomes in adolescents and young adults with Hodgkin lymphoma treated on US cooperative group protocols: An adult intergroup (E2496) and Children's Oncology Group (COG AHOD0031) comparative analysis
Outcomes in adolescents and young adults with Hodgkin lymphoma treated on US cooperative group protocols: An adult intergroup (E2496) and Children's Oncology Group (COG AHOD0031) comparative analysis
复制标题
DOI：
10.1002/cncr.30979
复制
发表时间：
2018-01-01
期刊：
影响因子：
6.2
通讯作者：
Evens, Andrew M.
中科院分区：
文献类型：
--
作者：
Henderson, Tara O.;Parsons, Susan K.;Evens, Andrew M.
背景：对于青少年和青壮年霍奇金淋巴瘤（HL）的治疗，儿科和成人医生之间没有明确的共识。方法：比较114例17至21岁HL患者的无失败生存期（FFS）和总生存期（OS），这些患者接受了东部肿瘤合作组-美国放射学院成像网络组间成人E2496研究，391例17至21岁HL患者接受了儿科儿童肿瘤组（COG） AHOD0031研究。结果：比较来自COG和E2496研究的aya，在淋巴外疾病、贫血或低白蛋白血症方面没有显著差异。E2496试验中更多的aya患有III期和IV期疾病（63%对29%，P < 0.001）和B期症状（63%对27%，P < 0.001），较少的aya患有整体疾病（33%对77%，P < 0.001）。COG试验中更多的aya接受了放疗（76% vs 66%; P = .03），尽管剂量较小。E2496组的5年FFS和OS率分别为68%和89%，COG组的5年FFS和OS率分别为81%和97%，与COG组相比具有统计学上的优势（P = 0.001）。在分层多变量分析中，除了没有贫血的I期和II期HL患者外，E2496 AYAs的FFS在所有阶层都比COG AYAs差。倾向评分分析（基于分期、贫血和整体疾病）证实E2496 AYAs的FFS较COG AYAs差（P = 0.004）。在E2496研究中，不同年龄组的FFS差异显著（P = 0.005）， 17 - 21岁的结果较22-44岁的结果差。在COG研究中，年龄之间没有差异。结论：在儿科试验中，年轻的AYA合并HL患者的治疗效果优于同龄的成人试验。对这些差异进行前瞻性研究是必要的。癌症2018;124:136-44。(c) 2017年美国癌症协会。
BACKGROUND: There is no clear consensus between pediatric and adult providers about the treatment of adolescents and young adults (AYAs) with Hodgkin lymphoma (HL). METHODS: Failure-free survival (FFS) and overall survival (OS) were compared between 114 patients ages 17 to 21 years with HL who were treated on the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Intergroup adult E2496 study and 391 similarly patients ages 17 to 21 years with HL who were treated on the pediatric Children's Oncology Group (COG) AHOD0031 study. RESULTS: Comparing AYAs from the COG and E2496 studies, there were no significant differences in extralymphatic disease, anemia, or hypoalbuminemia. More AYAs in the E2496 trial had stage III and IV disease (63% vs 29%; P < .001) and B symptoms (63% vs 27%; P < .001), and fewer had bulk disease (33% vs 77%; P < .001). More AYAs on the COG trial received radiotherapy (76% vs 66%; P = .03), although in smaller doses. E2496 AYA The 5-year FFS and OS rates were 68% and 89%, respectively in the E2496 AYAs and 81% and 97%, respectively, in the COG AYAs, indicating a statistically superior compared in the COG AYAs (P = .001). In stratified multivariable analyses, E2496 AYAs had worse FFS than COG AYAs in all strata except patients who had stage I and II HL without anemia. Propensity score analysis (based on stage, anemia, and bulk disease) confirmed inferior FFS for E2496 AYAs compared with COG AYAs (P = .004). On the E2496 study, FFS was significantly divergent across age groups (P = .005), with inferior outcomes for those ages 17 to 21 years versus 22-44 years. There was no difference across age on the COG study. CONCLUSIONS: Younger AYA patients with HL appear to have better outcomes when treated on a pediatric trial than patients of similar age on an adult trial. Prospective studies examining these differences are warranted. Cancer 2018;124:136-44. (c) 2017 American Cancer Society.