我们旨在研究在利妥昔单抗时代，放疗对早期弥漫性大B细胞淋巴瘤（DLBCL）的淋巴瘤相关死亡（LRD）发生率以及长期净生存效益。我们使用来自监测、流行病学和终点结果数据库的数据，对在2002年至2015年期间被诊断为早期DLBCL的10,841名成年患者进行了回顾性分析。将一线治疗分为联合模式治疗（CMT，n = 3,631）和仅化疗（n = 7,210）两组进行分类。使用竞争风险分析评估了死亡的累积发生率。使用倒数概率治疗加权（IPTW）进行组间平衡。通过相对生存率（RS），标准化死亡比率（SMR）和转化Cox回归来估计RT的净生存效益，同时控制背景死亡率。初始接受CMT治疗的患者与仅接受化疗的患者相比，LRD的累积发生率较低（HR 0.63，95%CI：0.57-0.69；P < 0.001）。CMT的10年总生存率（OS），RS和SMR分别为66.1%，85.0%和1.71，明显优于仅化疗的患者（53.0%；69.8%；2.62；所有P < 0.001）。IPTW和多变量分析显示，添加RT可改善OS（HR 0.67，95%CI：0.62-0.71；P < 0.001）和RS（HR 0.69，95%CI：0.65-0.74；P < 0.001）。此外，与仅化疗相比，CMT对早期DLBCL的OS和RS在诊断后的10年内的效益随时间增加。RT可以减少LRD，改善利妥昔单抗时代早期DLBCL的长期净生存。进一步的前瞻性研究有必要评估哪些特定患者人群会从早期DLBCL的巩固性RT中获益。 © 2023版权所有。Elsevier B.V.出版。

We aimed to investigate the incidence of lymphoma-related death (LRD) and the long-term net survival benefit of radiotherapy (RT) for early-stage diffuse large B-cell lymphoma (DLBCL) in the rituximab era.10,841 adults diagnosed with early-stage DLBCL between 2002-2015 were retrospectively analyzed using data from the Surveillance, Epidemiology, and End Results database. Primary therapy was categorized into combined-modality treatment (CMT, n = 3,631) and chemotherapy alone (n = 7,210). Competing risk analysis was used to evaluate the cumulative incidence of mortality. Inverse probability of treatment weighting (IPTW) was used to balance groups. The net survival benefit of RT was estimated through relative survival (RS), standardized mortality ratio (SMR), and transformed Cox regression, while controlling for background mortality.Patients initially treated with CMT had a lower cumulative incidence of LRD compared to those who received chemotherapy alone (HR 0.63, 95%CI: 0.57-0.69; P < 0.001). The 10-year overall survival (OS), RS, and SMR for CMT were 66.1%, 85.0%, and 1.71 respectively, which were significantly better than those for chemotherapy alone (53.0%; 69.8%; 2.62; all P < 0.001). IPTW and multivariable analysis revealed that the addition of RT led to better OS (HR 0.67, 95%CI: 0.62-0.71; P < 0.001) and RS (HR 0.69, 95%CI: 0.65-0.74; P < 0.001). Moreover, compared with chemotherapy alone, the benefit of OS and RS for CMT increased over time within 10 years of diagnosis.RT reduced LRD and improved the long-term net survival in early-stage DLBCL in the rituximab era. Further prospective studies are warranted to assess the specific patient population that would benefit the most from consolidative RT in early-stage DLBCL.Copyright © 2023. Published by Elsevier B.V.