129例原发鼻腔非霍奇金淋巴瘤的预后分析

背景与目的：原发鼻腔非霍奇金淋巴瘤（non-Hodgkin’s lymphoma,NHL）预后较差．远处转移和局部复发率均较高．目前本病尚无标准治疗原则。本研究主要探讨影响原发鼻腔NHL的预后因素。方法：1996年1月至2002年12月共收治129例经病理证实的原发鼻腔NHL。116例经病理形态学诊断为鼻腔NK／T细胞淋巴瘤。根据Ann Arbor分期,ⅠE期102例,ⅡE期22例,ⅣE期5例。124例ⅠE／ⅡE期患者单纯放疗22例,单纯化疗7例,45例放疗后化疗,50例化疗后放疗。5例ⅣE期以化疗为主。结果：全组5年总生存率（overall survival,OS）和无病生存率（disease-freely survival,DFS）分别是68．0％和55．8％。ⅠE期和ⅡE期患者的5年OS分别是71．7％和70．6％（P=0．77）,DFS分别是60．9％和47．0％（P=0．09）。首程治疗后完全缓解（complete response,CR）的患者5年OS为83．1％,而未达CR患者的5年OS为18．0％（P〈0．01）,相应5年DFS分别为68．0％和15．5％（P〈0．01）。国际预后指数（international prognostic index,IPl）评分为0,1和≥2的5年OS分别为81．1％、60．1％和14．3％（P〈0．01）,DFS分别为68．8％、44．6％和22．5％（P〈0．01）。38例患者治疗中进展或疗后复发,远处结外器官复发占78．9％,是治疗失败主要原因。单因素分析显示,首程治疗后的CR率、一般状态评分（performance status,PS）、IPI和修订后IPI与预后相关。多因素分析显示仅治疗后的CR率是独立预后因素。结论：治疗后的CR率是影响原发鼻腔NHL的重要预后因素,原因以远处病灶治疗失败为主。

Prognostic factors of primary non-Hodgkin's lymphoma of the nasal cavity--a report of 129 cases

BACKGROUND & OBJECTIVE: The prognosis of primary non-Hodgkin's lymphoma (NHL) of the nasal cavity was poor, and the distant metastasis and local relapse rates are high. This study was to analyze the prognostic factors of this disease. METHODS: Clinical data of 129 patients with pathologically confirmed nasal NHL, treated from Jan. 1996 to Dec. 2002, were retrospectively reviewed. Of the 129 patients, 116 were diagnosed as nasal NK/T-cell lymphoma. According to the Ann Arbor staging system, 102 patients had stage IE disease, 22 stage IIE, and 5 stage IVE. Among the 124 patients with stage IE or IIE disease, 22 received radiotherapy alone, 7 received chemotherapy alone, and 95 received combined modality therapy (CMT). Of the patients received CMT, 45 received radiotherapy followed by chemotherapy, and 50 received chemotherapy followed by radiotherapy. The stage IVE patients received chemotherapy with or without radiotherapy. RESULTS: The 5-year overall survival (OS) and disease-freely survival (DFS) rates for all patients were 68.0% and 55.8%, respectively. The 5-year OS and DFS rates were 71.7% and 60.9% for stage IE patients, and 70.6% and 47.0% for stage IIE patients, respectively (P>0.05). The 5-year OS and DFS rates were significantly higher in the patients who achieved complete response (CR) than in those who didn't (83.1% vs. 18.0%, 68.0% vs. 15.5%, P<0.01). The 5-year OS rates of the patients with international prognostic index (IPI) score of 0, 1, and > or =2 were 81.1%, 60.1%, and 14.3% (P<0.01), respectively; the 5-year DFS rates were 68.8%, 44.6%, and 22.5% (P<0.01), respectively. Thirty-eight patients developed progression or relapse, with distant extranodal dissemination (78.9%) as the primary pattern of failure. Univariate analysis showed that CR rate, PS, IPI, and modified IPI were related to prognosis. Multivariate analysis showed that CR rate was an independent prognostic factor. CONCLUSIONS: CR rate after treatment is an important prognostic factor of nasal NHL. Distant metastasis is the main failure pattern of nasal NHL.