| 摘要: | 原發性縱膈大B細胞淋巴瘤，簡稱為PMBCL，是一種發生於縱膈腔的淋巴瘤，主要好發於年輕的女性。此淋巴瘤為瀰漫性大B細胞淋巴瘤的其中一種亞型，雖然此疾病較為罕見，但是預後良好，有極高的機會是可以治癒而長期存活。在過去，由於缺乏隨機對照組試驗之相關研究，第一線治療採用和瀰漫性大B細胞淋巴瘤相同的R-CHOP化學療法。然而，在2013年時，Dunleavy等人發表一篇單組、第二階段之臨床試驗，在此篇研究的結果顯示使用DA-EPOCH-R化學療法對於病人整體存活期以及無疾病存活期有很好的效益。由於PMBCL較為罕見且缺乏隨機對照組試驗比較兩種治療的效果與安全性，且在目前被發表的觀察性研究當中，結果並不一致。因此，為了提供更佳的科學證據，我們進行系統性文獻回顧以及統合分析去評估DA-EPOCH-R與R-CHOP應用於PMBCL病人時的臨床效果與安全性。在此篇研究當中納入13篇研究，共974位病患。搜尋EMBASE、PUBMED、Cochrane Central Register of Controlled Trials (CENTRAL) 以及 ClinicalTrials.gov 等資料庫直到2022年3月19日。主結果為整體緩解率及完全緩解，其他結果包含一年與兩年的整體存活期、無疾病存活期與安全性相關的結果。另外，此篇研究針對疾病期別與放射線治療進行次分析。根據結果顯示使用DA-EPOCH-R治療能顯著改善整體緩解率(OR=0.36, 95% CI: 0.17-0.8)、完全緩解率(OR:0.55, 95% CI:0.36-0.84)以及兩年之整體存活期(OR:0.54, 95% CI:0.32-0.91)。不過對於一年之整體存活期(OR:0.63, 95% CI:0.25-1.56)、一年(OR:0.69, 95% CI:0.41-1.15)及兩年之無疾病存活期(OR:0.61, 95% CI:0.35-1.06)，兩組並無顯著差異。綜觀以上結果，DA-EPOCH-R作為原發性縱膈大B細胞淋巴瘤之一線治療時在初始治療後反應明顯比R-CHOP有效，而在整體存活期以及無疾病存活期之結果大多無顯著差異，尚待未來更多研究證實其效益。
Background and Purpose- Primary mediastinal large B cell lymphoma (PMBCL) is an uncommon subtype of non-Hodgkin’s lymphoma but a probably curable disease. In the past, the first-line treatment is similar to established therapy for diffuse large B cell lymphomas, which is R-CHOP immune-chemotherapy. However, a phase II study published in 2013 showed an excellent overall survival and event-free survival by using dose?adjusted (DA) EPOCH?R. Due to the relatively rare incidence of PMBCL, there is variation in clinical practice and the optimal first-line treatment strategy has not been identified. In order to achieve better scientific evidence, we performed this systematic review and meta-analysis to assess the efficacy and safety by comparing DA-EPOCH-R with R-CHOP chemotherapy from relevant studies.Methods- Thirteen observational studies (974 patients) were selected using EMBASE, PUBMED, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov from inception of databases to Mar 19, 2022 comparing DA-EPOCH-R with R-CHOP in patients with PMBCL. The primary efficacy outcome was overall survival rate and complete response. The secondary outcomes were overall survival, progression free survival and safety outcomes. We also conducted subgroup analysis based on disease stage and consolidative radiotherapy. Effects were estimated as odds ratio (OR) with 95% confidence interval. Results- DA-EPOCH-R significantly improved the overall response rate (OR=0.36, 95% CI: 0.17-0.8), complete response (OR:0.55, 95% CI:0.36-0.84) and 2-year overall survival (OR:0.54, 95% CI:0.32-0.91). However, DA-EPOCH-R regimen did not yield beneficial effect in terms of 1-year overall survival (OR:0.63, 95% CI:0.25-1.56), 1-year progression free survival (OR:0.69, 95% CI:0.41-1.15) and 2-year progression free survival (OR:0.61, 95% CI:0.35-1.06). Conclusion- DA-EPOCH-R is more effective in comparison to R-CHOP in patients with primary mediastinal B cell lymphoma after initial treatment and improved the 2-year overall survival. However, these two regimens have similar effects for the progression free survival. |
