CTOP与CHOP方案治疗老年非霍奇金淋巴瘤的临床对照研究

目的:探讨CTOP方案治疗初治的老年非霍奇金淋巴瘤(NHL)患者的疗效,缓解率、不良反应,T-cell淋巴瘤的有效率.方法:2002年1月～2006年1月我院收治的64例老年NHL,随机分为A、B 2组,A组:CTOP方案(环磷酰胺加吡柔比星加长春新碱加泼尼松),B组:CHOP方案以同等剂量的阿霉素(ADM)取代THP,余同A组.完成4周期后,根据病情放疗或加用博来霉素化疗.结果:A组完全缓解(CR) 71.9%,T-cell淋巴瘤CR 76.5%,2年总生存率53.1%.B组CR 62.5%,T-cell淋巴瘤CR47.1%,2年总生存率50%.A、B 2组比较CR率及2年生存率差异无统计学意义(均P>0.05),但T-cell淋巴瘤,CTOP方案优于CHOP方案,其CR率A组、B组分别为76.5%∶47.1%(P<0.01),脱发及心脏毒性CHOP增加.结论:CTOP方案适合老年NHL的治疗,尤其是对T-cell淋巴瘤有优势,明显降低毒性反应,尤其是心脏毒性反应.     

美罗华治疗B细胞性非霍奇金淋巴瘤的临床观察

目的:比较美罗华单药或联合化疗和单用CHOP方案治疗初治的B细胞性非霍奇金淋巴瘤的临床疗效及不良反应。方法:采用同期非随机对照的前瞻性研究方法,将51例初治B细胞淋巴瘤患者分为美罗华组和CHOP组,前组24例,采用美罗华单药或联合化疗;后组27例,单用CHOP方案化疗。3～6疗程后比较2组的疗效及不良反应。结果:美罗华组完全缓解(CR)率83.3%(20/24),总有效率(OR)95.8%(23/24);CHOP组CR率55.6%(15/27),OR率66.7%(18/27),2组疗效差异有统计学意义(P<0.05)。美罗华组2年的总生存率为70.8%,CHOP组为40.7%,美罗华组优于CHOP组(P<0.05)。结论:美罗华治疗初治B细胞淋巴瘤可取得较好疗效,2年生存率高,不良反应能耐受。     

三维适形序贯化放疗治疗Ⅲ期非小细胞肺癌的临床观察

目的探讨三维适形序贯化放疗治疗Ⅲ期非小细胞肺癌的疗效和不良反应。方法将84例Ⅲ期NSCLC患者随机分为两组:序贯治疗组(A)41例及单纯化疗组(B)43例,A组先采用GP方案化疗,先化疗2周期后行放疗,放疗结束后再行2周期化疗;B组采用GP方案化疗。结果序贯治疗组治疗有效率(CR+PR)68.29%;化疗组治疗有效率(CR+PR)34.88%,两组差异有显著性(P<0.05);1年生存率A组53.66%,B组25.58%,差异有显著性(P<0.05);2年生存率A组19.51%,B组11.63%,差异无显著性。两组病人均能耐受治疗中的不良反应。结论三维适形序贯化放疗可提高晚期NSCLC的近期疗效,毒性反应低,患者耐受性好。     

CHOP方案联合重组人肿瘤坏死因子α衍生物K2治疗非霍奇金淋巴瘤Ⅲ期临床研究

目的:评价CHOP方案联合重组人肿瘤坏死因子α衍生物K2(rh-TNFα-DK2)治疗非霍奇金淋巴瘤(NHL)的临床疗效、安全性和耐受性。方法:对46例NHL患者进行随机、双盲、对照的临床研究,分别以CHOP方案 rh-TNFα-DK2(试验组)和CHOP方案 安慰剂(对照组)化疗2个疗程。结果:试验组和对照组的缓解率/好转率分别为80.0%及43.8%(P<0.05)。治疗后试验组NK细胞数增加,与对照组有明显差异(P<0.05)。rh-TNFα-DK2最常见的不良反应为寒战和发热,发生率分别为34.4%和21.9%。结论:rh-TNFα-DK2与CHOP方案联合治疗NHL具有一定的协同作用,可提高临床缓解率和好转率,临床安全性较好,不增加CHOP方案的不良反应发生率。     

美罗华联合CHOP方案与依托泊苷联合CHOP方案治疗弥漫大B细胞淋巴瘤临床研究

目的回顾性研究美罗华联合CHOP(R-CHOP)方案和依托泊苷联合CHOP(E-CHOP)方案治疗弥漫大B细胞淋巴瘤(DLBCL)的疗效、生存率和不良反应。方法采用同期(2008年1月至2013年3月)非随机对照方法,将中国医科大学附属盛京医院收治的72例DLBCL患者分为2组,R-CHOP组37例,E-CHOP组35例,比较两组患者的疗效、生存率、无进展生存率及不良反应。结果 R-CHOP组患者完全缓解(CR)22例,部分缓解(PR)11例,总有效率(ORR)为89.2%(33/37);E-CHOP组CR11例,PR13例,ORR为68.6%(24/35),2组疗效比较差异有统计学意义(P=0.031);R-CHOP组和E-CHOP组1年总生存率分别为97.3%和94.3%,差异无统计学意义(P=0.609),1年无进展生存率分别为94.6%和74.3%,差异具有统计学意义(P=0.017)。两组患者的不良反应主要为胃肠道反应、轻中度骨髓抑制和输液相关不良反应,不良反应发生率相近,分别为37.8%和37.1%,差异无统计学意义(P0.05)。结论 R-CHOP方案能够提高治疗DLBCL患者的疗效,而不良反应未见明显增加,可作为该病治疗的一线方案。     

成人急性早幼粒细胞白血病治疗方案与疗效分析

目的:研究难治或复发性急性早幼粒细胞白血病(APL)不同诱导缓解方案的疗效,诱导缓解后不同巩固维持治疗方案对预后和生存率的影响。方法:APL57例(包括初次诱导未缓解与第1次复发的APL),按照不同的诱导缓解治疗方案分组(含砷剂组:单用亚砷酸组及亚砷酸加全反式维甲酸(ATRA)联合治疗组;不含砷剂组:单用化疗组)比较各组的完全缓解率(CR)和达到CR的时间;按照不同的缓解后治疗方案分组(亚砷酸/全反式维甲酸/化疗序贯治疗组;化疗组)比较各组复发率、总生存率(OS)、无病生存率(DFS)。采用SPSS10.0软件进行统计学分析(χ2检验、t检验、MannWhitney检验、Kaplan-Meier生存曲线、Log-Rank检验)。结果:含砷剂(亚砷酸)组诱导CR率可达80,明显高于不含亚砷酸组CR率(61.4±9.04)(P<0.05);含砷剂组达到CR时间(36.36±9.56)d,较不含亚砷酸组(47.26±22.21)d显著缩短(P<0.01)。诱导缓解后的治疗对生存影响显著,全反式维甲酸、亚砷酸、蒽环类化疗序贯治疗组复发率9.0,低于化疗组38.9(P<0.05)。序贯治疗组1年、3年生存率是(74.56±4.57)、(60.09±4.64),而化疗组1年、3年生存率仅为(57.84±8.01)、(49.13±13.14)(P<0.05)。序贯治疗组的3年DFS(71.48±1.94),显著高于化疗组的DFS(51.32±13.72)(P<0.05)。结论:含有亚砷酸诱导缓解方案诱导缓解率高,达CR时间短。全反式维甲酸、亚砷酸、蒽环类化疗序贯治疗复发率低,长期生存率高。监测PML/RARa融合基因对提示复发和调整治疗有重要意义。     

美罗华加沙利度胺联合化疗治疗侵袭性B细胞非霍奇金淋巴瘤的疗效分析

目的：评价美罗华联合沙利度胺化疗治疗侵袭性B-细胞非霍奇金淋巴瘤的临床疗效。方法：采用前瞻性对照分析,对60例侵袭性B-细胞非霍奇金淋巴瘤患者随机分成2组,即美罗华＋CHOP组（对照组）和美罗华＋CHOP＋反应停组（观察组）,比较2组患者的总有效率,总生存及无进展生存。结果：观察组：CR28例（80%）,PR5例（14.3%）,总有效率（CR＋PR）94.3%。对照组：CR25例（72%）,PR3例（12%）,总有效率（CR＋PR）84%。2组有显著差异（P〈0.05）。总生存：观察组：35例患者1年、2年、3年OS率分别为91.4%（32/35）,85.7%（30/35）,74.3%（26/35）;对照组：25例患者1年、2年、3年OS率分别为84%（21/25）,64%（16/25）,52%（13/25）,2组有显著差异（P〈0.05）。无进展生存率比较：观察组：35例患者1年、2年、3年PFS率分别为88.6%（31/35）,71.4%（25/35）,57%（20/35）;对照组：25例患者1年、2年、3年PFS率分别为68%（17/25）,52%（13/25）,36%（9/25）,2组有显著差异（P〈0.05）。而且不良反应轻。结论：美罗华联合反应停化疗治疗侵袭性B-NHL疗效显著,不良反应轻,值得临床推荐。     

鼻腔NK/T细胞淋巴瘤68例临床分析

目的探讨鼻腔NK/T细胞淋巴瘤各种治疗方法及影响预后的因素。方法回顾性分析该院收治68例鼻腔NK/T细胞淋巴瘤,其中男性45例,女性23例,中位年龄46岁。32例采用了单纯放疗,7例单纯化疗,29例放疗与化疗联合治疗。放疗采用直线加速器6MV X线或电子线,或钴~(60)照射。IE期患者照射野采用"L"形野,"凸"形野,或耳前野加筛窦野,颈部淋巴结不做预防性照射。Ⅱ期患者在肿瘤侵及颈部时应用面颈联合野和下颈切线野,加或不加筛窦电子线野。中位放疗剂量50 Gy。化疗采用CHOP方案,4～8个疗程。结果单纯放疗组CR率87.5%,5年生存率68.75%;单纯化疗组CR率14.3%,5年生存率14.3%;放化疗联合组,其中先化疗后放疗者,CR率65.2%,5年生存率60.9%;先放疗后化疗者,CR率83.3%,5年生存率66.7%。Ⅰ期患者CR率78.2%,5年生存率65.5%;Ⅱ期患者CR率60%,5年生存率50%;Ⅲ/Ⅳ期患者CR率和5年生存率为0。结论鼻腔NK/T细胞淋巴瘤放疗的疗效明显优于化疗。鼻腔NK/T细胞淋巴瘤对放疗敏感,而对化疗相对抗拒。早期鼻腔NK/T细胞淋巴瘤患者应接受放射治疗或以放疗为主的综合治疗。晚期患者预后极差,晚分期是独立的预后不良因素。     

GIP方案治疗难治性或复发性非霍奇金淋巴瘤的临床观察

随着化疗的进展,非霍奇金淋巴瘤(NHL)的化疗效果不断提高.对NHL患者,目前常规采用以联合化疗方案(环磷酰胺 阿霉素 长春新碱 泼尼松,CHOP)为主的综合治疗,但一部分NHL患者起始治疗时即对化疗耐药,或经过治疗达到完全缓解后很快复发.     

DICE方案治疗中、高度恶性非霍奇金淋巴瘤47例疗效观察

将94例中、高度恶性非霍奇金淋巴瘤（NHL）患者均分为两组，观察组采用DICE方案治疗，对照组采用CHOP方案治疗。结果观察组缓解率为78．7％，对照组为55．3％，两组比较有统计学差异（P〈0．01）；观察组1、3、5a生存率分别为89．4％、78．1％,47．6％，对照组分别为80．9％、52．0％、33．3％，两组比较有统计学差异（P〈0．05）。两组不良反应无统计学差异。认为DICE方案治疗中、高度恶性NHL疗效高，安全性好，优于CHOP方案。     

A comparative study of CHOP therapy and COP-BLAM therapy for non-Hodgkin's lymphoma in elderly patients]

Elderly patients (aged greater than or equal to 65 years) with non-Hodgkin's lymphoma were treated either with CHOP or COP-BLAM therapy, and the effectiveness and reverse effects of COP-BLAM therapy were compared with those of CHOP therapy. Thirty-three patients (aged greater than or equal to 65 years) with previously untreated non-Hodgkin's lymphoma were entered either on CHOP or COP-BLAM regimen between September, 1979 and February 1990. To CHOP therapy was performed in 15 patients (median age; 70 years). Eight of them had diffuse large cell type lymphoma (large), five had diffuse medium-sized cell type (medium) and two had diffuse mixed cell type (mixed). As to clinical stage, there were patients in stage II, 4 in stage III and 9 in stage IV in CHOP group. Of 18 patients (median age; 68 years), who were treated with COP-BLAM therapy, 8 had of large lymphoma and 10 medium lymphomas in histopathological classification. In terms of clinical stage, there were 5 patients in stage II, 4 in stage III and 9 in stage IV. CHOP therapy and COP-BLAM therapy were performed according to the method reported by McKelvey et al, and by Laurence et al., respectively, using the full doses of drugs without consideration the age. Complete remission (CR) was achieved in seven (46.7%) of 15 patients treated with CHOP therapy. In this group, five (38.5%) of 13 patients in advanced stages (stage III or IV) entered CR. Of 18 patients subjected to COP-BLAM therapy, 15 (83.3%) achieved CR. Among 13 patients in advanced stage treated with COP-BLAM therapy, CR was achieved in 11 (84.6%).(ABSTRACT TRUNCATED AT 250 WORDS)     

氟达拉滨联合米托蒽醌与CHOP方案治疗恶性淋巴瘤的疗效比较

目的评价并比较氟达拉滨联合米托蒽醌与CHOP方案治疗恶性淋巴瘤的疗效及安全性。方法将2002年8月至2006年2月于中国医科大学附属第一医院接受化疗的恶性淋巴瘤患者66例,按照治疗方案分成氟达拉滨联合米托蒽醌组(简称“氟达拉滨组”)和CHOP组,对2组的疗效及不良反应进行分析和比较。结果氟达拉滨组总有效率为81·5%,而CHOP组为48·7%;对晚期淋巴瘤、B细胞淋巴瘤及伴有血清乳酸脱氢酶(LDH)升高的淋巴瘤患者氟达拉滨组总有效率均高于CHOP组,组间比较差异均有显著性意义(P均<0·05)。氟达拉滨组血液学不良反应与CHOP组类似,而非血液学不良反应较少。结论以氟达拉滨为基础的联合化疗方案治疗初治恶性淋巴瘤以及难治、复发、晚期的恶性淋巴瘤的疗效、安全性及患者的耐受性均优于CHOP方案。     

Intensive conventional chemotherapy (ACVBP regimen) compared with standard CHOP for poor-prognosis aggressive non-Hodgkin lymphoma

We conducted a randomized trial to compare the intensive conventional chemotherapy regimen ACVBP (doxorubicin, cyclophosphamide, vindesine, bleomycin, prednisone) with standard CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) in previously untreated patients with poor-risk aggressive lymphoma. Patients aged 61 to 69 years who had aggressive non-Hodgkin lymphoma with at least one prognostic factor of the age-adjusted international prognostic index (IPI) were included. ACVBP consisted of an induction phase of intensified chemotherapy and central nervous system (CNS) prophylaxis followed by a sequential consolidation phase. Of the 708 patients registered for the study, 635 were eligible. The rate of complete response was 58% in the ACVBP group and 56% in the CHOP group (P =.5). Treatment-related death occurred in 13% of the ACVBP group and 7% of the CHOP group (P =.014). At 5 years, the event-free survival was 39% in the ACVBP group and 29% in the CHOP group (P =.005). The overall survival was significantly longer for patients treated with ACVBP, at 5 years it was 46% compared with 38% for patients treated with CHOP (P =.036). CNS progressions or relapses were more frequent in the CHOP group (P =.004). Despite higher toxicity, the ACVBP regimen, used as first-line treatment for patients with poor-risk aggressive lymphoma, is superior to standard CHOP with regard to both event-free survival and overall survival.     

Weekly CHOP chemotherapy in the treatment of intermediate-grade non-Hodgkin's lymphomas--cooperative group study by seven institutes

Between 1985 and 1988, 49 previously untreated patients with intermediate-grade non-Hodgkin's lymphoma (LSG classification large cell 35 including 11 large cell immunoblastic by Working Formulation, medium-sized cell 7, mixed 7) were treated with the Weekly CHOP regimen (three successive weekly administration of cyclophosphamide, doxorubicin, vincristine and prednisolone) as a cooperative group study by seven institutes (Nagoya Lymphoma Study Group). Complete remission was achieved in 63.3% with Weekly CHOP alone and finally in 79.6% after the addition of radiotherapy and/or combination chemotherapies including etoposide, methotrexate, procarbazine, bleomycin. Patients with T cell phenotype, high grade PS and the presence of bulky mass had significantly lower rates of CR. After a median follow-up 36 months Kaplan-Meier estimates showed that overall survival was 60.4%, disease-free survival 51.4% and relapse-free survival 64.6%. The major toxicities were alopecia, leukopenia, infection, neuropathy and gastrointestinal symptoms. No treatment-related deaths were observed. Survival was adversely affected by high LDH level, poor PS, T cell phenotype, the presence of B symptoms and the bulky mass. But these characteristics gave no significant effects on relapse rate and relapse-free survival. Thus, Weekly CHOP is an effective treatment for intermediate-grade NHL.     

Study of optimal CHOP dose ranges for elderly patients with non-Hodgkin's lymphoma

Two groups of intermediate-to high-grade non-Hodgkin's lymphoma patients aged 65 years and over were enrolled in a dose-range study of CHOP therapy utilizing 5 doses (1/2, 7/12, 2/3, 5/6, full CHOP): 11 patients 65-79 years of age (group A) and 9 patients 80 years or older (group B). The patients were enrolled consecutively; the study was designed so that if 3 patients completed 3 cycles of CHOP on schedule without major problems, the next highest dose was administered. If 2 patients experienced any major problems during 6 cycles at a given dose, treatment was discontinued and the dose prior to that particular dose was regarded as the optimal dose. The 6 treatment cycles were completed by 3 of 3 (2/3 CHOP), 3 of 4 (5/6 CHOP), and 1 of 4 (full CHOP) group A patients; and by 3 of 3 (1/2 CHOP), 2 of 3 (7/12 CHOP) and 1 of 3 (2/3 CHOP) group B patients. The results indicated that the optimal doses for group A and B were five-sixths and seven-twelfths of the standard CHOP dose, respectively.     

Gem-(R)CHOP versus (R)CHOP: a randomized phase II study of gemcitabine combined with (R)CHOP in untreated aggressive non-Hodgkin's lymphoma--EORTC lymphoma group protocol 20021 (EudraCT number 2004-004635-54)

Background: Despite recent improvements, many patients with aggressive non‐Hodgkin’s lymphoma (NHL) ultimately succumb to their disease. Therefore, improvements in front‐line chemotherapy of aggressive NHL are needed. Gemcitabine is active in lymphoma. Methods: We performed a randomized phase II trial of the addition of gemcitabine to standard CHOP chemotherapy with or without rituximab [(R)CHOP]. The trial was also designed to determine the maximal tolerated dose (MTD) of gemcitabine in this combination. Patients with previously untreated aggressive NHL were randomized to receive either eight cycles of (R)CHOP given every 3 wk or (R)CHOP combined with gemcitabine [Gem‐(R)CHOP]. Results: Twenty‐five patients were enrolled in the trial before early closure. Twelve were randomized to Gem‐(R)CHOP and 13 to (R)CHOP. MTD of gemcitabine was 800 mg/m² given on days 1 and 8; dose‐limiting toxicity was hematologic. Five patients (42%) treated with Gem‐(R)CHOP achieved complete response in comparison with 10 (77%) treated with (R)CHOP. Median time to treatment failure was 1.5 yr for Gem‐(R)CHOP and 3.1 yr for (R)CHOP. Three patients receiving Gem‐(R)CHOP had serious pulmonary toxicity, when compared to none receiving (R)CHOP. One patient died of pneumonitis. Conclusions: In this group of patients, addition of gemcitabine did not seem to improve outcomes. Gem‐(R)CHOP in previously untreated patients with aggressive NHL occasionally results in severe, potentially fatal, pulmonary toxicity.     

A case of malignant lymphoma concomitant with multiple myeloma

A 75-year-old woman was referred to us because of cough, high fever and skin erythema in April 1999. Malignant lymphoma (diffuse mixed cell type) was previously diagnosed in 1990 and she achieved complete remission after treatment with a series of CHOP regimen treatments. In 1998, multiple myeloma (IgG lambda type) was diagnosed and she was treated with a combination of melphalan and prednisolone. On physical examination, superficial lymphadenopathy and skin erythema were noted. Biclonal gammopathy (IgG kappa/lambda) was shown in serum, and Bence Jones protein in urine. Computed tomography showed pleural effusion and swelling of paraaortic lymph nodes. The bone marrow examination showed an increased number of abnormal plasma cells (19.2%) and no evidence of lymphoma. Left axillary lymph node biopsy revealed that she had non-Hodgkin's lymphoma (immunoblastic lymphadenopathy-like T cell lymphoma). She was treated with the CHOP regimen at reduced doses for both diseases. The lymphoadenopathy reduced after 6 courses of CHOP and 4 courses of CHOPE (CHOP + VP16), however, she had bone pain on November 1999 and received treatment with MCNU-VMP (MCNU + VDS + L-PAM + PSL). Her rib pain improved, but she died of systemic infection of herpes zoster virus. We report here a rare case of malignant lymphoma concomitant with multiple myeloma.     

Epirubicin-based combination chemotherapy combined with G-CSF for the elderly patients with non-Hodgkin's lymphoma

We devised a new epirubicin-based combination chemotherapy (Epi-COP) regimen for the patients with elderly non-Hodgkin's lymphoma and have treated 30 patients aged 66 years and older who had measurable diseases. In Epi-COP therapy, epirubicin was used as a substitute for doxorubicin in the CHOP regimen, and some dose modifications were made for the other agents. Combined modality treatment (CMT; chemotherapy plus radiotherapy) was adopted for 9 patients with localized disease. Complete response was obtained in 21 of all the 30 patients (70%), 8 in 9 (89%) of the CMT group and 13 in 21 (62%) of the patients with chemotherapy only (chemotherapy group). The median follow up time is 350 days, ranging from 2 to 77 months. The 2 year survival rate was 56% in all patients, 67% in the CMT group and 52% in the chemotherapy group. Granulocyte colony-stimulating factor (G-CSF) was administered when the leucocyte count decreased below 2,000/microliter, and 16 patients received it in the first course. The regimen could be repeated every three weeks in most cases. Although we encountered two early deaths, the overall toxicity level seemed to be acceptable. Even when we take account of the small number of patients and the short observation period, it might be concluded that Epi-COP was effective in inducing a good remission rate with moderate toxic effect in elderly patients with non-Hodgkin's lymphoma and CMT should be adopted if it is localized. A randomized comparative study with the CHOP regimen is necessary.     

Modified CHOP in an aged patient with non-Hodgkin's lymphoma and probable extensive pulmonary involvement.

A 75-year-old female was admitted to our hospital because of shortness of breath and palpitations. Chest roentgenogram together with a CT scan showed multiple nodular shadows in both lung fields, with hilar lymphadenopathy. The cervical lymph nodes were enlarged, and were biopsied to reveal diffuse large T-cell non-Hodgkin's lymphoma. Extensive pulmonary involvement was suspected and treatment with a modified CHOP regimen was begun. Following therapy, pulmonary symptoms were remarkably improved, and chest roentgenogram revealed virtually complete clearance of lung lesions. No severe side effects were observed as a result of the therapy.     

Full-dose CHOP chemotherapy combined with granulocyte colony-stimulating factor for aggressive non-Hodgkin's lymphoma in elderly patients: a prospective study

We assessed the efficacy and safety of full-dose CHOP regimen plus granulocyte colony-stimulating factor to treat aggressive non-Hodgkin's lymphoma in elderly patients. Forty-two patients with untreated disease were included in this study, aged 70-79 years, with stage II or higher disease and a performance status of 0-3, without severe organ dysfunction. Of the 40 patients who could be evaluated 87.5% achieved complete remission, with a 4-year survival rate of 69% and a 3-year progression-free survival rate of 49%. When stratified by the International prognostic Index, the 4-year survival rate was 90.9% for the low and low-intermediate risk group and 41.3% for the high-intermediate and high risk group, whereas the 3-year progression survival rate was 87.7% and 11.3%, respectively. Grade 3 or 4 hematological toxicity was found in 31 instances of granulocytopenia (77.5%) and 7 of anemia (17.5%). Nonhematological toxicity of grade 3 or 4 included pneumonia in two patients, heart failure in one, and gastrointestinal bleeding in one. Full-dose CHOP regimen with granulocyte colony-stimulating factor support could achieve a high-dose intensity in elderly patients whose general physical condition was good and hence achieved a high complete remission rate, but the disease often recurred within 2 years. Consequently, a new therapeutic strategy needs to be established, particularly for patients with high-intermediate or high risk.