滤泡性淋巴瘤 (FL) 和边缘区淋巴瘤 (MZL) 通常具有较长的总生存期 (OS)，然而，高级别转化 (HGT) 为弥漫性大 B 细胞淋巴瘤 (DLBCL) 会显着降低生存期。前期治疗与观察对 HGT 发生率和结果的作用仍不清楚。因此，我们分析了 SEER 数据库来解决这个问题。 2000 年至 2020 年间诊断为 FL 1-2 级和 MZL 的患者均纳入其中。 Fine 和 Gray 模型估计了协变量对 HGT 累积发生率和淋巴瘤特异性生存率 (LSS) 以及 Cox 回归对 OS 的影响。 HGT 发生在 23,384 名 FL 患者中的 4.2% 和 20,530 名 MZL 患者中的 2.5%。 FL 的 5 年和 10 年 HGT 累积发生率分别为 2.80% 和 4.87%，MZL 的 1.74% 和 2.95%，明显低于早期研究。 FL 和所有 MZL 亚型的年 HGT 发病率在前两年达到峰值，然后在二十年里稳步下降。在 FL 中，预先观察与治疗相比会增加 HGT 风险（SHR 1.23；95%CI：1.09-1.40，p<0.001），并且几乎不影响 OS（HR 0.95；95%CI 0.90-0.99，p=0.03）。相反，前期观察与结节（SHR 0.71；95%CI：0.53-0.94，p=0.01）和结外（SHR 0.64；95%CI：0.48-0.86，p=0.003）MZL 较低的 HGT 风险相关，但与 MZL 没有相关性。影响结外疾病的生存（HR 0.94；95%CI：0.97-1.02，p=0.15）。 HGT 与所有组织学中 LSS 的减少有关。前期治疗仅降低 FL 的 HGT 风险，但不能降低 MZL。版权所有 © 2024 美国血液学会。

Follicular lymphoma (FL) and marginal zone lymphoma (MZL) often have long overall survival (OS), however, high-grade transformation (HGT) to diffuse large B-cell lymphoma (DLBCL) markedly reduces survival. The roles of upfront treatment versus observation on the incidence and outcome of HGT remain unclear. Thus, we analyzed a SEER database to address this question. Patients diagnosed with FL grades 1-2 and MZL between 2000 and 2020 were included. Fine and Gray models estimated impact of covariates on HGT cumulative incidence and lymphoma-specific survival (LSS) and Cox regression on OS. HGT occurred in 4.2% of 23,384 FL and 2.5% of 20,530 MZL patients. The 5- and 10-year HGT cumulative incidence rates were 2.80% and 4.87% for FL, and 1.74% and 2.95% for MZL, respectively, which are notably lower than in earlier studies. The annual HGT incidence rate peaked in the first two years, then steadily declined over two decades for FL and all MZL subtypes. In FL, upfront observation versus treatment increases HGT risk (SHR 1.23; 95%CI: 1.09-1.40, p<0.001) and barely affects OS (HR 0.95; 95%CI 0.90-0.99, p=0.03). Conversely, upfront observation was associated with lower HGT risk in nodal (SHR 0.71; 95%CI: 0.53-0.94, p=0.01) and extranodal (SHR 0.64; 95%CI: 0.48-0.86, p=0.003) MZL and did not affect survival in extranodal disease (HR 0.94; 95%CI: 0.97-1.02, p=0.15). HGT was associated with decrease in LSS across all histologies. Upfront treatment reduced the risk of HGT only in FL but not MZL.Copyright © 2024 American Society of Hematology.