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著者: Julia J Scarisbrick, H Miles Prince, Maarten H Vermeer, Pietro Quaglino, Steven Horwitz, Pierluigi Porcu, Rudolf Stadler, Gary S Wood, Marie Beylot-Barry, Anne Pham-Ledard, Francine Foss, Michael Girardi, Martine Bagot, Laurence Michel, Maxime Battistella, Joan Guitart, Timothy M Kuzel, Maria Estela Martinez-Escala, Teresa Estrach, Evangelia Papadavid, Christina Antoniou, Dimitis Rigopoulos, Vassilki Nikolaou, Makoto Sugaya, Tomomitsu Miyagaki, Robert Gniadecki, José Antonio Sanches, Jade Cury-Martins, Denis Miyashiro, Octavio Servitje, Cristina Muniesa, Emilio Berti, Francesco Onida, Laura Corti, Emilia Hodak, Iris Amitay-Laish, Pablo L Ortiz-Romero, Jose L Rodríguez-Peralto, Robert Knobler, Stefanie Porkert, Wolfgang Bauer, Nicola Pimpinelli, Vieri Grandi, Richard Cowan, Alain Rook, Ellen Kim, Alessandro Pileri, Annalisa Patrizi, Ramon M Pujol, Henry Wong, Kelly Tyler, Rene Stranzenbach, Christiane Querfeld, Paolo Fava, Milena Maule, Rein Willemze, Felicity Evison, Stephen Morris, Robert Twigger, Rakhshandra Talpur, Jinah Kim, Grant Ognibene, Shufeng Li, Mahkam Tavallaee, Richard T Hoppe, Madeleine Duvic, Sean J Whittaker, Youn H Kim
雑誌名: J Clin Oncol. 2015 Nov 10;33(32):3766-73. doi: 10.1200/JCO.2015.61.7142. Epub 2015 Oct 5.
Abstract/Text
PURPOSE: Advanced-stage mycosis fungoides (MF; stage IIB to IV) and Sézary syndrome (SS) are aggressive lymphomas with a median survival of 1 to 5 years. Clinical management is stage based; however, there is wide range of outcome within stages. Published prognostic studies in MF/SS have been single-center trials. Because of the rarity of MF/SS, only a large collaboration would power a study to identify independent prognostic markers.
PATIENTS AND METHODS: Literature review identified the following 10 candidate markers: stage, age, sex, cutaneous histologic features of folliculotropism, CD30 positivity, proliferation index, large-cell transformation, WBC/lymphocyte count, serum lactate dehydrogenase, and identical T-cell clone in blood and skin. Data were collected at specialist centers on patients diagnosed with advanced-stage MF/SS from 2007. Each parameter recorded at diagnosis was tested against overall survival (OS).
RESULTS: Staging data on 1,275 patients with advanced MF/SS from 29 international sites were included for survival analysis. The median OS was 63 months, with 2- and 5-year survival rates of 77% and 52%, respectively. The median OS for patients with stage IIB disease was 68 months, but patients diagnosed with stage III disease had slightly improved survival compared with patients with stage IIB, although patients diagnosed with stage IV disease had significantly worse survival (48 months for stage IVA and 33 months for stage IVB). Of the 10 variables tested, four (stage IV, age > 60 years, large-cell transformation, and increased lactate dehydrogenase) were independent prognostic markers for a worse survival. Combining these four factors in a prognostic index model identified the following three risk groups across stages with significantly different 5-year survival rates: low risk (68%), intermediate risk (44%), and high risk (28%).
CONCLUSION: To our knowledge, this study includes the largest cohort of patients with advanced-stage MF/SS and identifies markers with independent prognostic value, which, used together in a prognostic index, may be useful to stratify advanced-stage patients.
© 2015 by American Society of Clinical Oncology.
PMID 26438120 J Clin Oncol. 2015 Nov 10;33(32):3766-73. doi: 10.1200/JCO.2015.61.7142. Epub 2015 Oct 5.
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