Prognostic impact of six versus eight cycles of standard regimen in patients with diffuse large B-cell lymphoma: propensity score-matching analysis.
Prognostic impact of six versus eight cycles of standard regimen in patients with diffuse large B-cell lymphoma: propensity score-matching analysis.
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DOI：
10.1016/j.esmoop.2021.100210
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发表时间：
2021-08
期刊：
影响因子：
7.3
通讯作者：
Yamauchi T
中科院分区：
文献类型：
--
作者：
Oiwa K;Fujita K;Lee S;Morishita T;Tsukasaki H;Negoro E;Hara T;Tsurumi H;Ueda T;Yamauchi T
R-CHOP-21 一直是弥漫性大 B 细胞淋巴瘤 (DLBCL) 的标准治疗方法，但缺乏关注治疗周期数的证据。我们进行了一项回顾性研究，使用倾向评分匹配，并考虑相对剂量强度 (RDI)，比较 6 个周期的标准治疗方案与 8 个周期的 DLBCL 患者总生存 (OS) 的有效性。 2007年至2017年，三个机构总共鉴定了685名新诊断的DLBCL患者。使用六个周期标准方案治疗的患者通过倾向评分与使用八个周期治疗的患者进行匹配。 1:1 倾向评分匹配产生了 138 对患者。在传统 Cox 比例风险模型中，八个周期并未显着改善 OS（风险比 0.849，95% 置信区间 0.453-1.588，P = 0.608）。 OS 的限制三次样条 Cox 模型证实，周期数的影响不会因总平均 RDI、国际预后指数和年龄而改变。六个周期和八个周期之间不良事件的发生率没有差异。即使考虑到RDI的影响，DLBCL初始标准方案的6个周期也不逊色于8个周期。对于新诊断的 DLBCL，包括 R-CHOP-21 在内的标准治疗方案的最佳周期数尚未确定。本研究旨在验证标准治疗方案的六个周期或八个周期是否可以改善 DLBCL 的预后。本研究使用倾向评分匹配和带有限制三次样条的 Cox 风险模型。即使考虑到 RDI，八个周期与六个周期相比也没有观察到生存获益。在年龄和 IPI 修改后，(R-)CHOP-21 或 THP-COP-21 八个周期的预后并不比六个周期更好。
R-CHOP-21 has been the standard treatment for diffuse large B-cell lymphoma (DLBCL), but there is a paucity of evidence focusing on the number of cycles of regimens. We conducted a retrospective study to compare the effectiveness of six cycles of standard regimens versus eight cycles for overall survival (OS) in DLBCL patients using propensity score matching, in consideration of relative dose intensity (RDI). A total of 685 patients with newly diagnosed DLBCL were identified in three institutions from 2007 to 2017. Patients treated using six cycles of standard regimens were matched by propensity scores with those treated using eight cycles. A 1 : 1 propensity score matching yielded 138 patient pairs. Eight cycles did not significantly improve OS in the conventional Cox proportional hazards model (hazard ratio 0.849, 95% confidence interval 0.453-1.588, P = 0.608). Restricted cubic spline Cox models for OS confirmed that the effect of the number of cycles was not modified by total average RDI, the International Prognostic Index, and age. Occurrence of adverse events did not differ between six and eight cycles. Even considering the impact of RDI, six cycles of the initial standard regimen for DLBCL is not inferior to eight cycles. The optimal number of cycles of standard regimens including R-CHOP-21 for newly diagnosed DLBCL has not been determined. This study was conducted to verify whether six cycles or eight cycles of standard regimen improved the prognosis of DLBCL. Propensity score matching and a Cox hazards model with restricted cubic spline were used in this study. No survival benefit of eight cycles compared with six cycles was seen, even taking into account RDI. Prognosis was no better with eight cycles of (R-)CHOP-21 or THP-COP-21 than with six cycles, after age and IPI modifications.
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