Impact Of Tumor Size Change After Chemotherapy On The Survival Of Patients With Nodal Early Diffuse Large B-cell Lymphoma Treated With Chemotherapy Combined With Radiotherapy

Objective:To retrospectively analyze how the changes of tumor size after chemotherapy have effect on the result of comprehensive threapy(chemotherapy plus radiotherapy)in nodal early diffuse large B-cell lymphoma(DLBCL)patients.Methods:A total of 57 patients with stage Ⅰ-Ⅱ nodal DLBCL who were newly diagnosed in the Hunan Cancer Hospital from 2011 to 2015 were enrolled among whom 32 were male and 25 were female,with an average age of 46.6 years,ranging from 21 to 75.The median age was 50 years old.All patients received comprehensive therapy(chemotherapy plus radiotherapy).The changes of tumor size before and after CHOP/RCHOP chemotherapy were analyzed through enhanced CT scans by the sum of longest diameters(SLD)and the sum of the products of the perpendicular diameters(SPPD).Receiver operating characteristic(ROC)curve was used to determine the optimal cutoff value of the decreased percentage of SLD(△SLD%)and that of SPPD(ΔSPPD%).Patients were grouped according to the cutoff value.X 2 test,Kaplan Meier survival analysis and COX proportional hazard model analysis were used to compare the prognostic value of each factor for progression-free survival(PFS)and overall survival(OS).Results:The optimal cutoff value for △SLD%to predict disease progression in DLBCL patients was 55.7%.In the ΔSLD%<55.7%group,3-year PFS was 63.6%,5-year PFS was 54.5%,3-year OS was 77.2%,5-year OS was 72.7%.In the ΔSLD%≥ 55.7%group,3-year PFS was 97.1%,5-year PFS was 94.3%,3-year OS was 97.1%,5-year OS was 94.3%.The optimal cutoff value for ΔSPPD%to predict disease progression in DLBCL patients was 62.9%.In the ΔSPPD%<62.9%group,3-year PFS was 38.5%,5-year PFS was 23.1%,3-year OS was 61.5%,5-year OS was 53.8%.In the ΔSPPD%≥62.9%group,3-year PFS was 97.7%,5-year PFS was 95.5%,both 3-year and 5-year OS were 95.5%.The differences were statistically significant.Univariate analysis showed that ΔSLD%<55.7%and ΔSPPD%<62.9%were risk factors affecting prognosis(PFS and OS).The results of the multivariate COX proportional hazard model analysis showed that ΔSPPD%<62.9%was an independent risk factor for patients with DLBCL(PFS:P=0.0040,hazard ratio 13.248;OS:P=0.046,hazard ratio 7.156).Conclusions:In patients with nodal early stage DLBCL after CHOP/R-CHOP chemotherapy,ΔSLD%and ΔSPPD%were important prognostic factors for predicting PFS and OS.They were clinical significance for early DLBCL risk stratification while the predictive value of ΔSPPD%was greater than that of ΔSLD%.