Three prognostic factors influence clinical outcomes of primary testicular lymphoma.

The standard treatment of primary testicular lymphoma (PTL) has not been well established. Our study aimed to evaluate the relationship between the prognostic factors and clinical outcomes of PTL. We retrospectively reviewed the clinical records of 43 PTL patients and included the 39 patients who were diagnosed with primary testicular diffuse large B cell lymphoma (DLBCL) for analysis of prognostic factors and assessment of treatment modalities. Cox regression analysis showed that poor ECOG performance status (PS, ≥2), infiltration of adjacent tissues (spermatic cord, epididymis, or scrotum), and bulky disease (tumor mass, >9 cm) were independent predictors of worse overall survival (OS) for primary testicular DLBCL. According to these three factors, the patients were divided into two groups. Rituximab was found to significantly prolong progression-free survival (PFS) in the low-risk group (P = 0.044) but not in the high-risk group (P = 0.748). And the combination therapy for CNS prophylaxis significantly prolonged the survival in the high-risk group (P = 0.005 for OS; P = 0.004 for PFS), but not in the low-risk group (P = 0.092 for OS; P = 0.191 for PFS). ECOG performance status, infiltration of adjacent tissues, and bulky disease are practical prognostic factors of survival in patients with primary testicular DLBCL. The addition of rituximab is more important for the patients without the prognostics factors, and the combination CNS prophylaxis is more significant for the patients with the prognostics factors.

Prognostic value of interim and posttherapy 18F-FDG PET/CT in patients with mature T-cell and natural killer cell lymphomas.

UNLABELLED: The prognostic value of interim PET or PET/CT performed after 1-4 cycles of chemotherapy has been widely confirmed in Hodgkin lymphoma and diffuse large B-cell lymphoma but remains unknown in T-cell and natural killer (T/NK) cell lymphomas. Therefore, our aim was to investigate the prognostic value of interim and posttherapy PET/CT in T/NK-cell lymphomas. METHODS: A retrospective analysis was conducted on data from 88 patients with newly diagnosed T/NK-cell lymphoma who underwent interim (after 1-4 cycles of chemotherapy, n = 62) or posttherapy PET/CT (after the completion of first-line therapy, n = 47). Interim and posttherapy PET/CT status (positive vs. negative) was visually interpreted according to criteria of the International Harmonization Project, and PET/CT status was assessed for its ability to predict progression-free survival (PFS) and overall survival (OS). RESULTS: Interim PET/CT results were negative in 17 of 62 (27.4%) cases, and posttherapy PET/CT results were negative in 29 of 47 (61.7%) cases. The 2-y PFS and OS rates were 71.9% and 80.2%, respectively, in patients with negative results at interim PET/CT versus 20.5% and 46.9%, respectively, in patients with positive results (P < 0.001 and P = 0.022, respectively). The 2-y PFS and OS rates were 57.8% and 78.0%, respectively, in patients with negative results on posttherapy PET/CT versus 0% and 20.4%, respectively, in patients with positive results (P < 0.001 and P = 0.003, respectively). Bivariate analysis showed that interim PET/CT status and posttherapy PET/CT status remain independent predictors of PFS and OS after controlling for the score on the Prognostic Index for Peripheral T-Cell Lymphoma, Unspecified. CONCLUSION: Both interim PET/CT status and posttherapy PET/CT status are independent predictors of PFS and OS in T/NK-cell lymphomas.

Comparison of five cisplatin-based regimens frequently used as the first-line protocols in metastatic nasopharyngeal carcinoma.

BACKGROUND AND OBJECTIVE: No randomized trial has been reported comparing different chemotherapy regimens on disseminated nasopharyngeal carcinoma (NPC). This study aims to compare five cisplatin-based regimens including cisplatin + 5-fluororacil (PF), paclitaxel + cisplatin (TP), gemcitabine + cisplain (GP), paclitaxel + cisplatin + 5-fluororacil (TPF), and bleomycin + cisplatin + 5-fluororacil (BPF) regimen most frequently used as the first-line protocols for metastatic NPC retrospectively. METHODS: Eight hundred and twenty-two patients with metastatic NPC were divided into five groups according to the regimen they received. Then, their response rate, toxicity, and long-term survival outcome as well as the prognostic factors were analyzed. RESULTS: The higher response rates in GP and TPF regimens comparing to PF regimen were achieved (Χ (2) = 4.57, P = 0.033; Χ (2) = 7.04, P = 0.008), as well as in TPF regimen comparing to TP regimen (Χ (2) = 5.579, P = 0.018). The occurrence rate of the major III-IV grade toxicity was significantly different between the five groups. However, no statistically significant difference was observed in progression-free survival (PFS; P = 0.247) and overall survival (P = 0.127) among the five groups. Cox multivariate analysis identified the following independent prognostic factors: liver metastases, plasma Epstein Barr Virus (EBV)-DNA level, cycles of chemotherapy, and second-line chemotherapy. CONCLUSIONS: PF, TP, and GP are all effective regimens as the first-line chemotherapy for metastatic NPC, which can be well tolerated. Over four cycles of chemotherapy are recommended under no contraindication. Patients should transfer to the second-line regimen after the treatment failure of the first-line chemotherapy.