85例结外鼻型NK/T细胞淋巴瘤治疗及预后的回顾性观察

目的 探讨结外鼻型NK/T细胞淋巴瘤(Extranodal NK/T-cell lymphoma,nasal type ENKL,NKTCL)的临床特征、免疫组化特征、预后评估方式、干预措施对预后的影响.方法 回顾性分析2013年1月至2017年4月就诊于我中心、经病理确诊为NKTCL的85例患者的随访资料(平均年龄46.25岁,男女性别比例约2∶1).依据Ann Arbor分期评估结果分别接受单纯放疗、单纯化疗、放化疗联合等3种不同方案的治疗,纳入临床特征、Ann Arbor分期、国际预后指数(international prognostic index,IPI)评分、ECOG(eastern cooperative oncology group)评分、EB病毒(epstein-barr virus,EBV)、乳酸脱氢酶(lactate dehydrogenase,LDH)、病理免疫组化、治疗方案等指标,运用Kaplan-Meier及多因素Cox比例风险等统计学法分析上述指标对NKTCL生存的影响.结果 85例患者完全缓解率(complete response rate,CR)为41.1％,部分缓解率(partial response rate,PR)为21.1％,中位生存时间为37个月.1、3、5年的总生存率分别为68.2％、48.4％、32.7％,疾病无事件生存率(event-free survival rate,EFS)分别为56.0％、45.3％、31.8％.单因素分析结果显示:Ann Arbor分期、IPI、ECOG评分、LDH、淋巴瘤B症状、白细胞数、血红蛋白、灶性CD20、EBV等对NKTCL的预后影响有统计学意义(P＜0.05);其中Ann Arbor分期、IPI评分、ECOG评分是NKTCL的独立预后因素.单纯放疗、单纯化疗、联合放化疗对生存率的影响无显著性差异(P＞0.05).结论 淋巴瘤B症状、高LDH、异常白细胞、低血红蛋白、灶性CD20(-)、EBV(+)与NKTCL预后相关;AnnArbor分期、ECOG、IPI评分可作为其独立预后指标.

Treatment and outcomes of extranodal natural killer/T cell lymphoma,nasal type:a retrospective analysis of 85 cases

Objective To analyze the impact of clinical features,immunohistochemical characteristics,prognostic evaluation and interventions on the outcomes of patients with nasal-type extranodal natural killer/T cell lymphoma (NKTCL).Methods This retrospective study was conducted among 85 patients (median age of 46.25 years,male/female ratio of 2 ∶ 1) with the pathological diagnosis of NKTCL treated in our center between January,2013 and April,2017.Based on Ann Arbor staging results,the patients received 3 different treatment regimens,namely radiotherapy alone,chemotherapy alone,and radiotherapy combined with chemotherapy.The impact of clinical characteristics,Ann Arbor staging,International Prognostic Index (IPI) scores,Eastern Cooperative Oncology Group (ECOG) scores,EpsteinBarr virus (EBV) positivity,lactate dehydrogenase (LDH),pathological and immunohistochemical findings,and treatment regimens on the outcomes of the patients was analyzed using Kaplan-Meier method and multifactor Cox proportional risk analysis.Results The 85 patients had a complete response rate (CR) of 41.1％ and a partial response rate (PR) of 21.1％.The median survival time of the patients was 37 months,with the 1-,3-,and 5-year overall survival rates (OS) of 68.2％,48.4％ and 32.7％,and 1-,3-,and 5-year event-free survival rates (EFS) of 56％,45.3％ and 31.8％,respectively.Univariate analysis showed that Ann Arbor stages,IPI scores,ECOG scores,LDH level,B symptoms,white blood cell count,hemoglobin,focal CD20 and EBV positivity were significant factors affecting the prognosis of patients with NKTCL (P ＜ 0.05);Ann Arbor stages,IPI scores and ECOG scores were independent prognostic factors of NKTCL.Different treatment regimens (radiotherapy,chemotherapy,either alone or in combination) did not significantly affect the outcomes of the patients.Conclusion The presence of B symptoms,a high LDH level,abnormal white blood cell count,a low hemoglobin,focal CD20 negativity and EBV positivity are all associated with the a poor prognosis of NKTCL;Ann Arbor stage,ECOG scores and IPI scores can be used as independent factors for predicting the prognosis of NKTCL.