Association of Combined Modality Therapy vs Chemotherapy Alone With Overall Survival in Early-Stage Pediatric Hodgkin Lymphoma
Association of Combined Modality Therapy vs Chemotherapy Alone With Overall Survival in Early-Stage Pediatric Hodgkin Lymphoma
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DOI：
10.1001/jamaoncol.2018.5911
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发表时间：
2019-05-01
期刊：
影响因子：
28.4
通讯作者：
Parikh, Rahul R.
中科院分区：
文献类型：
--
作者：
Jhawar, Sachin R.;Rivera-Nunez, Zorimar;Parikh, Rahul R.
重要性迄今为止，对于早期儿童霍奇金淋巴瘤（HL）尚无明确的标准治疗，可能包括单独化疗或化疗后放疗的联合治疗（CMT）。虽然使用放射治疗在儿科HL正在减少，这种策略仍然存在争议。目的研究CMT在儿科HL的使用及其与提高总生存率的关系，使用数据从一个大型癌症登记。设置.这项观察性队列研究使用来自美国国家癌症数据库的数据，评价了2004年1月1日至2015年12月31日期间在美国接受I期或II期HL诊断的5657例儿科患者（年龄：0.1-21岁）的临床特征和生存结局。统计分析时间为2018年5月1日至11月1日。EXPOSURES患者接受化疗或CMT的确定性治疗，定义为化疗后放疗。主要结局和指标Kaplan-Meier生存曲线用于检查总生存期。在多变量考克斯比例风险回归模型中评估CMT使用、协变量和总生存期之间的相关性。随着时间的推移，对放射治疗的使用进行了评估。结果：在国家癌症数据库中的11546例儿童HL患者中，分析了5657例I期或II期经典HL患者（3004例女性，2596例男性，57例性别信息缺失;平均[SD]年龄为17.1 [3.6]岁）。在这些患者中，2845例（50.3%）接受了CMT;使用CMT与单独化疗相比，
IMPORTANCE To date, there is no well-defined standard of care for early-stage pediatric Hodgkin lymphoma (HL), which may include chemotherapy alone or combined modality therapy (CMT) with chemotherapy followed by radiotherapy. Although the use of radiotherapy in pediatric HL is decreasing, this strategy remains controversial.OBJECTIVE To examine the use of CMT in pediatric HL and its association with improved overall survival using data from a large cancer registry.DESIGN. SETTING. AND PARTICIPANTS This observational cohort study used data from the National Cancer Database to evaluate clinical features and survival outcomes among 5657 pediatric patients (age, 0.1-21 years) who received a diagnosis of stage I or II HL in the United States from January 1, 2004, to December 31, 2015. Statistical analysis was conducted from May 1 to November 1, 2018.EXPOSURES Patients received definitive treatment with chemotherapy or CMT, defined as chemotherapy followed by radiotherapy.MAIN OUTCOMES AND MEASURES Kaplan-Meier survival curves were used to examine overall survival. The association between CMT use, covariables, and overall survival was assessed in multivariable Cox proportional hazards regression models. Use of radiotherapy was assessed over time. RESULTS Among the 11546 pediatric patients with HL in the National Cancer Database, 5657 patients (3004 females, 2596 males, and 57 missing information on sex; mean [SD] age, 17.1 [3.6] years) with stage I or II classic HL were analyzed. Of these patients, 2845 (50.3%) received CMT; use of CMT vs chemotherapy alone was associated with younger age (