Risk-Dependent Conditional Survival and Failure Hazard After Radiotherapy for Early-Stage Extranodal Natural Killer/T-Cell Lymphoma

Liu, Xin; Wu, Tao; Zhu, Shijun; Shi, Mei; Wang, Ying; He, Xia; Xu, Li; Yuan, Zhi Yong; Zhang, L.; Wu, Gang; Qu, Baolin; Li, Qian; Hou, Xuwei; Zhang, Fu Quan; Zhang, Yu Jing; Zhu, Yuan; Cao, Jian; Lan, Sheng Hui; Wu, Jun; Qi, S.; Yang, Yong; Li, Ye Xiong

doi:10.1001/jamanetworkopen.2019.0194

Cited by 27 publications

(49 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consistently in our recent analyses, [20][21][22][23] the risk of failure and death was high initially, but decreased dramatically over time in intermediate-risk/high-risk patients treated with non-ANT-based CT and RT, whereas it remained constantly low in low-risk patients primarily treated with RT. 20 Radiotherapy for elderly patients without risk factors (stage II, elevated LDH, ECOG score ≥ 2, PTI) achieved a very favorable OS equivalent to the age-matched and sex-matched general Chinese population. 21 These findings suggest that RT with or without CT is a viable treatment option for low-risk early-stage patients in the modern CT era.…”

Section: Discussionsupporting

confidence: 88%

“…[14][15][16][17][18][19] In recent pooled studies from the China Lymphoma Collaborative Group (CLCG), new CT regimens significantly improved survival compared with ANT-based regimens, regardless of stage and age. [20][21][22][23] However, RT remained an essential component of first-line therapy for early-stage patients, 22,23 even after complete response (CR) to asparaginase (ASP)-based CT. 24,25 Note, RT increased survival probability and decreased hazards of failure in a risk-dependent manner. [20][21][22]26 With the advent of new CT regimens, 11,[14][15][16][17][18][19] the survival benefit of CT in addition to RT in early-stage patients in different risk groups should be determined.…”

Section: Introductionmentioning

confidence: 99%

“…[20][21][22][23] However, RT remained an essential component of first-line therapy for early-stage patients, 22,23 even after complete response (CR) to asparaginase (ASP)-based CT. 24,25 Note, RT increased survival probability and decreased hazards of failure in a risk-dependent manner. [20][21][22]26 With the advent of new CT regimens, 11,[14][15][16][17][18][19] the survival benefit of CT in addition to RT in early-stage patients in different risk groups should be determined. [23][24][25] In the ANT-based CT era, early or upfront RT followed by CT confers survival benefit over late RT or CT followed by RT for early-stage ENKTCL.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Risk‐based, response‐adapted therapy for early‐stage extranodal nasal‐type NK/T‐cell lymphoma in the modern chemotherapy era: A China Lymphoma Collaborative Group study

Yang

Zhang

et al. 2020

American J Hematol

Self Cite

View full text Add to dashboard Cite

We aimed to determine the survival benefits of chemotherapy (CT) added to radiotherapy (RT) in different risk groups of patients with early‐stage extranodal nasal‐type NK/T‐cell lymphoma (ENKTCL), and to investigate the risk of postponing RT based on induction CT responses. A total of 1360 patients who received RT with or without new‐regimen CT from 20 institutions were retrospectively reviewed. The patients had received RT alone, RT followed by CT (RT + CT), or CT followed by RT (CT + RT). The patients were stratified into different risk groups using the nomogram‐revised risk index (NRI). A comparative study was performed using propensity score‐matched (PSM) analysis. Adding new‐regimen CT to RT (vs RT alone) significantly improved overall survival (OS, 73.2% vs 60.9%, P < .001) and progression‐free survival (PFS, 63.5% vs 54.2%, P < .001) for intermediate‐risk/high‐risk patients, but not for low‐risk patients. For intermediate‐risk/high‐risk patients, RT + CT and CT + RT resulted in non‐significantly different OS (77.7% vs 72.4%; P = .290) and PFS (67.1% vs 63.1%; P = .592). For patients with complete response (CR) after induction CT, initiation of RT within or beyond three cycles of CT resulted in similar OS (78.2% vs 81.7%, P = .915) and PFS (68.2% vs 69.9%, P = .519). For patients without CR, early RT resulted in better PFS (63.4% vs 47.6%, P = .019) than late RT. Risk‐based, response‐adapted therapy involving early RT combined with CT is a viable, effective strategy for intermediate‐risk/high‐risk early‐stage patients with ENKTCL in the modern treatment era.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk‐based, response‐adapted therapy for early‐stage extranodal nasal‐type NK/T‐cell lymphoma in the modern chemotherapy era: A China Lymphoma Collaborative Group study

Yang

Zhang

et al. 2020

American J Hematol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Furthermore, there is an urgent requirement to identify patients at high risk of early progression who would benefit from innovative treatment strategies. Following the achievement of PFS24, research for ENKTCL survivors should focus on lessintensive surveillance, long-term treatment toxicity, quality of life, and other outcomes [34,37,38]. Previous studies, mainly using the randomized controlled trial (RCT) or real-world data, have demonstrated that the surrogate endpoints of EFS and PFS are strongly related to OS at both trial-and individual-level in different lymphoma subtypes [26-29, 32, 39-41].…”

Section: Discussionmentioning

confidence: 99%

Progression-free survival at 24 months and subsequent survival of patients with extranodal NK/T-cell lymphoma: a China Lymphoma Collaborative Group (CLCG) study

et al. 2020

Self Cite

View full text Add to dashboard Cite

Limited evidence supports the use of early endpoints to evaluate the success of initial treatment of extranodal NK/T-cell lymphoma (ENKTCL) in the modern era. We aim to analyze progression-free survival at 24 months (PFS24) and subsequent overall survival (OS) in a large-scale multicenter cohort of patients. 1790 patients were included from the China Lymphoma Collaborative Group (CLCG) database. Subsequent OS was defined from the time of PFS24 or progression within 24 months to death. OS was compared with age- and sex-matched general Chinese population using expected survival and standardized mortality ratio (SMR). Patients who did not achieve PFS24 had a median OS of 5.3 months after progression, with 5-year OS rate of 19.2% and the SMR of 71.4 (95% CI, 62.9–81.1). In contrast, 74% patients achieved PFS24, and the SMR after achieving PFS24 was 1.77 (95% CI, 1.34–2.34). The observed OS rate after PFS24 versus expected OS rate at 5 years was 92.2% versus 94.3%. Similarly, superior outcomes following PFS24 were observed in early-stage patients (5-year OS rate, 92.9%). Patients achieving PFS24 had excellent outcome, whereas patients exhibiting earlier progression had a poor survival. These marked differences suggest that PFS24 may be used for study design and risk stratification in ENKTCL.

show abstract

“…CS denotes the probability of survival for an additional

y

years given an existing survival time of

x

years, which is calculated as

C S (y | x) = S (x + y) / S (x)

. The concept of CS can extend to multiple endpoints, deriving conditional OS (COS), conditional DFS (CDFS), conditional LRRFS (CLRRFS), conditional DMFS (CDMFS) and conditional NPC‐SS (CNPC‐SS) [1,3,26]. For example, the 3‐year CDFS at 5 years demonstrates the probability of being disease‐free for an additional 3 years given an existing disease‐free time of 5 years.…”

Section: Methodsmentioning

confidence: 99%

Development and validation of a web‐based calculator to predict individualized conditional risk of site‐specific recurrence in nasopharyngeal carcinoma: Analysis of 10,058 endemic cases

Wu¹,

Li²,

Mao³

et al. 2020

Cancer Communications

View full text Add to dashboard Cite

BackgroundConditional survival (CS) provides dynamic prognostic estimates by considering the patients existing survival time. Since CS for endemic nasopharyngeal carcinoma (NPC) is lacking, we aimed to assess the CS of endemic NPC and establish a web‐based calculator to predict individualized, conditional site‐specific recurrence risk.MethodsUsing an NPC‐specific database with a big‐data intelligence platform, 10,058 endemic patients with non‐metastatic stage I–IVA NPC receiving intensity‐modulated radiotherapy with or without chemotherapy between April 2009 and December 2015 were investigated. Crude CS estimates of conditional overall survival (COS), conditional disease‐free survival (CDFS), conditional locoregional relapse‐free survival (CLRRFS), conditional distant metastasis‐free survival (CDMFS), and conditional NPC‐specific survival (CNPC‐SS) were calculated. Covariate‐adjusted CS estimates were generated using inverse probability weighting. A prediction model was established using competing risk models and was externally validated with an independent, non‐metastatic stage I–IVA NPC cohort undergoing intensity‐modulated radiotherapy with or without chemotherapy (n = 601) at another institution.ResultsThe median follow‐up of the primary cohort was 67.2 months. The 5‐year COS, CDFS, CLRRFS, CDMFS, and CNPC‐SS increased from 86.2%, 78.1%, 89.8%, 87.3%, and 87.6% at diagnosis to 87.3%, 87.7%, 94.4%, 96.0%, and 90.1%, respectively, for an existing survival time of 3 years since diagnosis. Differences in CS estimates between prognostic factor subgroups of each endpoint were noticeable at diagnosis but diminished with time, whereas an ever‐increasing disparity in CS between different age subgroups was observed over time. Notably, the prognoses of patients that were poor at diagnosis improved greatly as patients survived longer. For individualized CS predictions, we developed a web‐based model to estimate the conditional risk of local (C‐index, 0.656), regional (0.667), bone (0.742), lung (0.681), and liver (0.711) recurrence, which significantly outperformed the current staging system (P < 0.001). The performance of this web‐based model was further validated using an external validation cohort (median follow‐up, 61.3 months), with C‐indices of 0.672, 0.736, 0.754, 0.663, and 0.721, respectively.ConclusionsWe characterized the CS of endemic NPC in the largest cohort to date. Moreover, we established a web‐based calculator to predict the CS of site‐specific recurrence, which may help to tailor individualized, risk‐based, time‐adapted follow‐up strategies.

show abstract

Risk-Dependent Conditional Survival and Failure Hazard After Radiotherapy for Early-Stage Extranodal Natural Killer/T-Cell Lymphoma

Abstract: This cohort study assesses changes in survival probabilities and failure hazard after radiotherapy in adult patients with early-stage extranodal natural killer/T-cell lymphoma based on risk categories, previous survival, and treatment.

Cited by 27 publications

References 52 publications

Risk‐based, response‐adapted therapy for early‐stage extranodal nasal‐type NK/T‐cell lymphoma in the modern chemotherapy era: A China Lymphoma Collaborative Group study

Risk‐based, response‐adapted therapy for early‐stage extranodal nasal‐type NK/T‐cell lymphoma in the modern chemotherapy era: A China Lymphoma Collaborative Group study

Progression-free survival at 24 months and subsequent survival of patients with extranodal NK/T-cell lymphoma: a China Lymphoma Collaborative Group (CLCG) study

Development and validation of a web‐based calculator to predict individualized conditional risk of site‐specific recurrence in nasopharyngeal carcinoma: Analysis of 10,058 endemic cases

Contact Info

Product

Resources

About