中国癌症杂志 ›› 2018, Vol. 28 ›› Issue (9): 698-705.doi: 10.19401/j.cnki.1007-3639.2018.09.009

• 论著 • 上一篇    下一篇

99例结外NK/T细胞淋巴瘤预后分析

宋玉芝,吴晓琳,甄婵军,李 静,白文文,乔学英   

  1. 河北医科大学第四医院放疗科,河北 石家庄 050011
  • 出版日期:2018-09-30 发布日期:2018-10-26
  • 通信作者: 乔学英 E-mail:xueying_qiao@126.com

Analysis of prognostic factors in 99 patients with extranodal NK/T cell lymphoma

SONG Yuzhi, WU Xiaolin, ZHEN Chanjun, LI Jing, BAI Wenwen, QIAO Xueying   

  1. Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
  • Published:2018-09-30 Online:2018-10-26
  • Contact: QIAO Xueying E-mail: xueying_qiao@126.com

摘要: 背景与目的:结外NK/T细胞淋巴瘤的临床及预后存在明显的异质性,以早期病变为主,常见原发灶局部外侵,早期患者放疗为主要治疗手段。本研究旨在分析早期结外NK/T细胞淋巴瘤患者的临床特征、治疗方案、生存预后及可能影响预后的相关因素。方法:收集河北医科大学第四医院2010年1月—2015年12月病理证实的早期NK/T细胞淋巴瘤患者99例,发病平均年龄45.5岁(6~76岁),男女发病比例2.1∶1;56.6%患者伴有B症状;单纯放疗7例,单纯化疗29例,放化综合治疗63例;中位放疗剂量52 Gy(34~60 Gy),含左旋门冬酰胺酶或培门冬酶化疗患者73例,不含19例,中位化疗周期为6个(1~12个)。结果:全组患者中位生存时间59.9个月,中位局控时间73.5个月。全组患者1、2和5年总生存率分别为76.8%、68.8%和61.4%;1、2和5年局控率分别为84.5%、81.6%和78.3%;1、2和5年无远处失败生存率分别为83.4%、83.4%和76.8%。单纯放疗或放化疗与单纯化疗比较,5年总生存率为66.0%和47.3%(χ2=4.782,P=0.029),5年局控率为85.8%和58.7%(χ2=5.949,P=0.015)。不伴原发肿瘤侵犯(primary tumor invasion,PTI)患者与伴有PTI患者比较,5年总生存率为71.5%和55.5%(χ2=4.950,P=0.026);5年局控率为81.5%和72.0%(χ2=0.983,P=0.321)。全组近期疗效评价达CR者62例(62.6%),治疗有效率83.8%,疾病控制率85.8%。评价CR患者与非CR患者5年生存率为84.1%和27.6%(χ2=31.566,P=0.000);5年局控率为92.2%和52.4%(χ2=18.417,P=0.000)。结论:早期结外NK/T细胞淋巴瘤患者单放或放化综合治疗比单纯化疗疗效好,与生存有关的独立预后因素有Ann Arbor分期和乳酸脱氢酶(lactate dehydrogenase,LDH),与局控有关的独立预后因素仅有LDH。

关键词: 淋巴瘤, 结外NK/T细胞, 放射治疗, 化学治疗, 预后

Abstract: Background and purpose: The clinical course and prognosis of extranodal NK/T cell lymphoma are highly variable. The majority of early-stage patients are treated primarily with radiotherapy. The primary tumor invasion (PTI) is a common clinical feature for the patients with extranodal NK/T cell lymphoma. The aim of this study was to analyze the clinical characteristics, treatment, survival and prognostic factors in patients with extranodal NK/T cell lymphoma. Methods: The study included a total of 99 patients with pathologically confirmed extranodal NK/T cell lymphoma in the Fourth Hospital of Hebei Medical University from Jan. 2010 to Dec. 2015. Mean age was 45.5 years (6-76 years); male to female ratio was 2.1 to 1. Of all patients, 56 (56.6%) had B symptoms, 7 received radiotherapy alone, 29 received chemotherapy alone, and 63 received concurrent chemoradiotherapy. Median radiation dose was 52 (34-60) Gy. There were 73 patients receiving chemotherapy with L-asparaginase or pegaspargase and 19 without. Median chemotherapy had 6 (1-12) cycles. Results: The median overall survival (OS) was 59.9 months for all patients. The median progression-free survival (PFS) was 73.5 months. The 1-, 2- and 5-year OS rates were 76.8%, 68.8% and 61.4%, respectively. The 1-, 2- and 5-year PFS rates were 84.5%, 81.6% and 78.3%, respectively. The 1-, 2- and 5-year distant failure-free survival (DFFS) rates were 83.4%, 83.4% and 76.8%, respectively. The patients who received radiotherapy alone and concurrent chemoradiotherapy had significantly longer survival time than those who received chemotherapy alone. The 5-year OS rates were 66.0% and 47.3% (χ2=4.782, P=0.029), respectively. The 5-year PFS rates were 85.8% and 58.7% (χ2=5.949, P=0.015), respectively. The 5-year OS rates of the patients with and without PTI were 71.5% and 55.5% (χ2=4.950, P=0.026), respectively. The 5-year PFS rates were 81.5% and 72.0% (χ2=0.983, P=0.321), respectively. The complete response (CR) was observed in 62.6% patients. The 5-year OS was 84.1% in patients with CR and 27.6% in no-CR (χ2=31.566, P=0.000), the 5-year PFS rates were 92.2% and 52.4% (χ2=18.417, P=0.000), respectively. Conclusion: Most patients with early-stage extranodal NK/T cell lymphoma who received radiotherapy alone and chemoradiotherapy had significantly longer survival time than those who received chemotherapy alone. Multivariate Cox regression analysis for OS showed that Ann Arbor stage and lactate dehydrogenase (LDH) were independent prognostic factors. LDH was the only independent prognostic factor for PFS.

Key words: Lymphoma, Extranodal natural killer/T-cell, Radiotherapy, Chemotherapy, Prognosis