早期胃原发弥漫大B细胞淋巴瘤的临床特点及治疗策略  

Clinical characteristics and treatment strategies for early-stage primary gastric diffuse large B-cell lymphoma

作　　者：秦燕[1] 刘鹏[1] 杨建良[1] 金晶[2] 何小慧[1] 王维虎[2] 房辉[2] 周生余[1] 周立强[1] 宋永文[2] 石远凯[1] Qin Yan;Liu Peng;Yang Jianliang;Jin Jing;He Xiaohui;Wang Weihu;Fang Hui;Zhou Shengyu;Zhou Liqiang;Song Yongwen;Shi Yuankai(National Cancer Center/ Cancer Hospital, Chinese Academy of Medical Sciences （CAMS） and Peking Union Medical College, National Centre for Anticancer Drug Clinical Study, Belting 100021, China)

机构地区：[1]国家癌症中心北京协和医学院中国医学科学院肿瘤医院肿瘤内科,100021 [2]国家癌症中心北京协和医学院中国医学科学院肿瘤医院放疗科,100021

出　　处：《中华医学杂志》2018年第24期1945-1950,共6页National Medical Journal of China

基　　金：国家科技支撑计划（2014BA109812）;中国医学科学院医学与健康科技创新工程（2016-12M-1-001）

摘　　要：目的探讨早期胃原发弥漫大B细胞淋巴瘤（PG－DLBCL）诱导化疗后达到完全缓解（CR）的患者是否需要巩固性放疗，以及利妥昔单抗联合CHOP（环磷酰胺＋阿霉素＋长春新碱＋泼尼松）方案（R－CHOP）的疗效是否优于CHOP方案。方法回顾性分析就诊于中国医学科学院肿瘤医院ⅠE和ⅡE期PG－DLBCL患者的临床资料，入选患者均未接受过手术治疗，以化疗为初始治疗，并至少接受3个周期的R－CHOP或CHOP样方案治疗，且疗效达CR或部分缓解（PR）。结果共91例PG－DLBCL患者纳入本研究，中位年龄51（16～81）岁，其中男47例，女44例；ⅠE期52例，ⅡE期39例；64例（70.3%）采用R－CHOP样方案，27例（29.7%） CHOP样方案，中位化疗周期数6（3～8）个。80例（87.9%）患者诱导化疗后获得CR，11例（12.1%）获得PR。CR患者中，48例（60%）进行了巩固性放疗，32例（40%）未行放疗；PR患者均接受了解救性放疗。接受和未接受放疗的CR患者，4年无进展生存（PFS）率分别为96.4%和96.7%（χ2 ＝0.546，P＝0.46）；7例（7/11）PR患者放疗后达到CR，中位随访41个月，均无病生存。一线采用R－CHOP或CHOP样方案治疗的患者，4年PFS分别为93.2%和89.7%（χ2 ＝0.096，P＝0.757）。结论诱导化疗后达CR的早期PG－DLBCL患者，巩固性放疗未显示改善PFS；但对于PR的患者，解救性放疗可提高CR率，并获得长期无病生存。R－CHOP对比CHOP方案，未显示改善疗效。Objective Primary gastric diffuse large B-cell lymphoma （PG-DLBCL） is the most common non-Hodgkin lymphoma （NHL） of extranodal origin. Most patients with PG-DLBCL had localized disease （stage Ⅰ or Ⅱ） at presentation, and will achieve complete response （CR） after induction chemotherapy. However, there has been little consensus regarding whether optimal treatment is provided by chemotherapy alone or chemotherapy plus radiotherapy, nor the treatment outcome from the addition of rituximab in localized-stage PG-DLBCL.Methods Patients with Stage ⅠE and ⅡE PG-DLBCL were retrospectively analyzed. Patients have not undergone surgery, have received at least 3 cycles of R-CHOP or CHOP-like chemotherapy as initial therapy, and achieved CR or partial response （PR） were enrolled.Results A total of 91 patients were studied. The median age was 51 years, included 47 males and 44 females. Fifty-two patients were at Stage ⅠE and 39 at Stage ⅡE, 64 （70.3%） patients received R-CHOP-like regimens, and 27 （29.7%） received CHOP-like regimens, the median chemotherapy cycle was 6 （3-8）. Among the 91 patients, 80 （87.9%） patients achieved CR from induction chemotherapy, 11（12.1%） was evaluated PR. Of CR patients, 48 patients （60%） underwent consolidating radiotherapy and 32 patients （40%） did not receive radiotherapy; all PR patients received salvage radiotherapy. CR patients with and without radiation therapy had 4-year progression-free survival （PFS） rates of 96.4% and 96.7%, respectively （χ2 = 0.546, P=0.46）; 7/11 （63.6%） PR patients achieved CR after radiotherapy, with a median follow-up of 41 months, they were all disease free. For patients treated with R-CHOP or CHOP-like regimens, the 4-year PFS was 93.2% and 89.7%, respectively （χ2=0.096, P=0.757）.Conclusions Consolidation radiotherapy failed to improve the outcome for early-stage PG-DLBCL, while for PR patients, salvage radiotherapy increased CR rate and improved survival. The addition of rituximab to CH

关 键 词：非霍奇金淋巴瘤 胃肿瘤 化疗 放疗 预后 生存 

分 类 号：R733.1[医药卫生—肿瘤]