中高危弥漫大B细胞淋巴瘤化疗后放疗的总生存期与无进展生存期的关系:系统综述与荟萃分析

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引用次数: 0

摘要

方法通过系统性文献检索确定了比较联合模式疗法(CMT)与单纯化疗(CT)的随机对照试验(RCT)和回顾性研究。加权回归分析用于估计OS和PFS获益之间的相关性。Cohen's kappa 统计评估了 DLBCL 风险模型与 PFS 模式之间的一致性。结果在7项RCT研究和52项回顾性研究中,试验水平的PFS HR(HRPFS)和OS HR(HROS)之间存在相关性(r = 0.639-0.876),治疗组水平的PFS和OS率之间也存在相关性,与CT方案无关(r = 0.882-0.964)。在CT中加入RT可增加约18%的PFS,并显示出不同的OS获益情况。患者被分为四种CT生成的PFS模式(80%、60%-80%、40%-60%和≤40%),这与风险分层亚组一致(kappa >0.6)。RT带来的OS绝对收益从PFS >80%时的≤5%到PFS≤40%时的约21%不等,基于利妥昔单抗的CT后的汇总HROS从0.70(95% CI,0.51-0.97)到0.48(95% CI,0.36-0.63)不等。RT的OS获益主要体现在PFS≤80%的中危和高危患者中。
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Association of overall survival benefit of radiotherapy with progression-free survival after chemotherapy for diffuse large B-cell lymphoma: A systematic review and meta-analysis

Objective

To evaluate whether improved progression-free survival (PFS) from radiotherapy (RT) translates into an overall survival (OS) benefit for diffuse large B-cell lymphoma (DLBCL).

Methods

A systematic literature search identified randomized controlled trials (RCTs) and retrospective studies that compared combined-modality therapy (CMT) with chemotherapy (CT) alone. Weighted regression analyses were used to estimate the correlation between OS and PFS benefits. Cohen's kappa statistic assessed the consistency between DLBCL risk-models and PFS patterns. Furthermore, the benefit trend of RT was analyzed by fitting a linear regression model to the pooled hazard ratio (HR) according to the PFS patterns.

Results

For both 7 RCTs and 52 retrospective studies, correlations were found between PFS HR (HRPFS) and OS HR (HROS) at trial level (r = 0.639–0.876), and between PFS and OS rates at treatment-arm level, regardless of CT regimens (r = 0.882–0.964). Incorporating RT into CT increased about 18% of PFS, and revealed a different OS benefit profile. Patients were stratified into four CT-generated PFS patterns (>80%, >60–80%, >40–60%, and ≤40%), which was consistent with risk-stratified subgroups (kappa > 0.6). Absolute gain in OS from RT ranged from ≤5% at PFS >80% to about 21% at PFS ≤40%, with pooled HROS from 0.70 (95% CI, 0.51–0.97) to 0.48 (95% CI, 0.36–0.63) after rituximab-based CT. The OS benefit of RT was predominant in intermediate- and high-risk patients with PFS ≤ 80%.

Conclusion

We demonstrated a varied OS benefit profile of RT to inform treatment decisions and clinical trial design.

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来源期刊
CiteScore
14.20
自引率
0.00%
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0
审稿时长
70 days
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