Background: The stage-specific roles of radiotherapy (RT) alone, chemotherapy alone, and chemoradiotherapy (CRT) for patients with nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) have not been adequately evaluated.
Methods: We analyzed patients with NLPHL in all stages enrolled from the Surveillance, Epidemiology, and End Results (SEER) registry from January 2000 to December 2015. Propensity score (PS) analysis with 1:1 matching was performed to ensure well-balanced characteristics between the comparison groups. Kaplan-Meier and Cox proportional hazards models were used to evaluate the overall survival (OS), cancer-specific survival (CSS), the hazard ratio (HR), and corresponding 95% confidence intervals (95% CI). Restricted mean survival times (RMST) were also used for the survival analyses.
Results: For early-stage patients, RT alone was found to be associated with the improved survival of 10 months to 15 months and the deceased HR of 60% to 80%. Chemotherapy alone also had survival benefits (improved OS = 12.1 months; improved CSS = 5.3 months). However, not all of these improvements were statistically significant. CRT was associated with the best survival: the mean OS was significantly improved by 20 months and the HR was reduced by more than 80%, both before and after PS matching (PSM) (P < 0.05). For advanced-stage patients, none of RT alone, chemotherapy alone, and CRT had a significant effect on survival. Chemotherapy alone and CRT might be more beneficial for long-term survival (RMST120m: neither RT nor chemotherapy vs. chemotherapy alone vs. CRT = 104m vs. 111m vs. 108m). Subgroup analysis showed that the efficacy of RT alone in patients with early-stage NLPHL was significantly different between younger people and older people (age < 40: HR, 95% CI = 5.70, 0.34 - 94.2, P = 0.224; age ≧ 40: HR, 95% CI = 0.06, 0.01 - 0.32, P = 0.001; P for interaction = 0.005).
Conclusions: The results from the large SEER database suggested that CRT was associated with the best survival of patients with the early-stage NLPHL. More effective treatment strategies for patients with advanced-stage NLPHL remain to be further studied.
Citation Format: Shijie Wang, Mingfang Jia, Jianglong Han, Rui Zhang, Kejie Huang, Yunfeng Qiao, Ping Chen, Zhenming Fu. The stage-specific roles of radiotherapy and chemotherapy in nodular lymphocyte-predominant Hodgkin lymphoma patients: A propensity-matched analysis of the Surveillance, Epidemiology, and End Results database [abstract]. In: Proceedings of the AACR Virtual Meeting: Advances in Malignant Lymphoma; 2020 Aug 17-19. Philadelphia (PA): AACR; Blood Cancer Discov 2020;1(3_Suppl):Abstract nr PO-60.