原发鼻腔T/NK-T细胞非霍奇金淋巴瘤34例临床分析

 目的 探讨原发鼻腔T细胞性非霍奇金淋巴瘤（NHL）的临床特点及治疗。方法 回顾分析1997年1月至2001年12月收治的鼻腔T细胞性NHL34例。其中23例用化、放疗联合治疗,9例用单纯化疗,2例未治疗。所有化疗均采用标准CHOP方案。结果 单纯化疗组有效率为44.4 ％,CR率为22.2 ％;化、放联合治疗组有效率为100.0 ％,CR率86.9 ％。全组1年、3年、5年生存率分别为52.9 ％,41.2 ％,18.3 ％。化、放联合治疗组5年生存率高于单纯化疗组;局限于鼻腔（ⅠE期）者,5年生存率高于有远处播散者（>ⅠE期）。结论 原发性鼻腔T细胞NHL 预后不良,用标准CHOP方案化疗疗效差,联合化、放疗有助于改善预后。     

37例鼻腔NK/T细胞淋巴瘤临床分析

目的分析鼻腔NK/T细胞淋巴瘤的临床特征、不同治疗方法的疗效及影响预后的因素。方法回顾性分析1999年12月至2008年4月收治的37例经病理证实的鼻腔NK/T细胞淋巴瘤患者的临床资料。根据AnnArbor分期,Ⅰ期17例,Ⅱ期15例,Ⅲ期1例,Ⅳ期4例。单纯放疗8例,单纯化疗9例,其余20例采用放化疗联合治疗。单因素分析采用Kap lan-M e ier法,多因素分析运用Cox比例风险模型。结果全组中位生存时间27月,3年总生存（OS）率为50.0%,放化疗联合、单纯放疗、单纯化疗3年生存率分别为77.8%、50.0%、0%。单纯放疗、放化疗联合治疗后3年生存率明显高于单纯化疗（P〈0.01）;放化疗联合与单纯放疗治疗后3年生存率无明显差异（P〉0.05）。单纯化疗CR 1例（11.1%）,单纯放疗CR 6例（75.0%）,放化疗联合CR 16例（80.0%）,单纯放疗、放化疗联合治疗后CR率明显高于单纯化疗（P〈0.01）;放化疗联合与单纯放疗治疗后CR率差异无统计学意义（P〉0.05）。单因素分析显示,PS评分、IPI、LDH水平、临床分期、治疗模式、首程治疗后CR率等与预后相关。多因素分析显示,首程治疗后CR率、PS评分是鼻腔NK/T细胞淋巴瘤预后不良的独立因素。结论鼻腔NK/T细胞淋巴瘤单纯放疗、放化疗联合近期疗效显著优于常规化疗,化疗加入放疗并未改善生存率。首程治疗后CR率、PS评分可作为判断鼻腔NK/T细胞淋巴瘤预后的参考因素。     

鼻腔自然杀伤/T细胞淋巴瘤放射治疗的疗效和影响因素

 目的　回顾分析鼻腔自然杀伤（NK）／T细胞淋巴瘤的放射治疗效果,并分析其预后因素。方法　回顾分析9年间接受放射治疗的62例鼻腔NK／T细胞淋巴瘤的临床资料和疗效,单因素分析采用Kaplan-Meier法,多因素分析用COX比例风险模型。结果　全组中位生存时间69.7个月（95 % CI为63.0～78.0个月）,3、5年总生存率分别为66.1 %和46.8 %,远处转移导致治疗失败占61.8 %。T淋巴细胞CD3升高组和降低组的中位生存时间分别为72.6个月和39.6个月,两组比较差异有统计学意义（χ2＝4.9309,P＝0.0264）。多因素分析表明,修正后国际预后指数（IPI）为0～1（χ2＝7.5266,P＝0.0061）、CD3升高（χ2＝9.0912,P＝0.0266）和治疗结束达到CR（χ2＝9.0912,P＝0.0106）是影响鼻腔NK／T细胞淋巴瘤放疗总生存的有利预后因素。结论　放射治疗鼻腔NK／T细胞淋巴瘤疗效肯定,但远处转移治疗失败率高,全身治疗仍具有重要地位;修正后IPI为0～1、CD3升高、治疗结束达到CR是影响鼻腔NK／T细胞淋巴瘤放疗总生存的有利预后因素。     

鼻型结外NK/T细胞淋巴瘤治疗的研究进展

结外NK/T细胞淋巴瘤,鼻型(ENKTL)是一种侵袭性非霍奇金淋巴瘤.ENKTL目前尚无标准治疗方案,局限期患者可考虑单纯放疗或放化疗联合治疗,多药联合化疗为晚期患者主要治疗手段,以蒽环类药物为主的传统化疗方案对ENKTL的疗效欠佳.近年,一些新的治疗方案在ENKTL中显示出一定的疗效,文章就ENKTL治疗的进展进行综述.     

Extranodal natural killer/T-cell lymphoma, nasal type: epidemiology study

Extranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKTCL) is a rarely kind of non-Hodgkin lymphoma (NHL). It is much more frequent in Asian and Latin American countries than other part of the world. It typically affects nasal cavity. In China, one of its endemically places, ENKTCL accounts for 74%–96% of nasal NHL. Patients with ENKTCL usually show a highly aggressive clinical course, and its etiology is unclear. However, it is already proved that ENKTCL is associated with Epstein-Barr virus (EBV) infection, regardless patients’, ethnicity and areas. Some studies show that the risk will increase among several occupations, such as farmer, who are frequently exposure to pesticides and chemical solvent and risk can be cut down if taking some protective measures.     

鼻腔NK/T细胞淋巴瘤患者的临床病理特征和预后因素分析

目的探讨鼻腔NK/T细胞淋巴瘤的临床病理特征及其预后影响因素。方法选择2010年8月至2014年10月就诊的鼻腔NK/T细胞淋巴瘤患者60例作为研究对象。根据患者治疗方法的不同分为观察A组和观察B组,观察A组32例,观察B组28例,其中观察A组患者给予调强根治性放疗技术或三维适形,观察B组患者给予CHOP(环磷酰胺+长春新碱+泼尼松+阿霉素)或DICE(地塞米松+异环磷酰胺+顺铂+依托泊甙)方案为主的诱导化疗。结果观察A组患者总有效率为81.3%,观察B组患者总有效率为82.1%,组间差异无统计学意义(P>0.05)。单因素分析结果显示,Ann Arbor分期、国际预后指数(IPI)评分、身体状况(PS)评分、乳酸脱氢酶(LDH)、球蛋白、白细胞和β2-微球蛋白与预后有关。多因素分析结果显示,LDH水平、首次治疗达到完全缓解(CR)和治疗模式为影响鼻腔NK/T细胞淋巴瘤预后的独立因素。结论 LDH水平、首次治疗达到CR以及治疗模式为影响鼻腔NK/T细胞淋巴瘤预后的参考指标,有助于指导临床工作。     

62例鼻型NK/T细胞淋巴瘤的预后因素分析

背景与目的:鼻型NK/T细胞淋巴瘤是具有独特生物学特性的疾病类型,由于发病率相对较低,其确切的临床预后特征尚未完全阐明。本研究拟分析华南地区鼻型NK/T细胞淋巴瘤的临床特点及可能的预后因素,为进一步的研究提供参考。方法:回顾性分析中山大学肿瘤防治中心1999年1月至2004年12月间收治的鼻型NK/T细胞淋巴瘤患者的资料。详细的临床特点及实验室检查结果均纳入单因素分析,单因素分析中有统计学意义的指标纳入多因素分析。结果:62例鼻型NK/T细胞淋巴瘤患者纳入本研究,男女比例约为3∶1,患者中位年龄42岁。92%的患者为AnnArborⅠ/Ⅱ期,76%的患者属于IPI(internationalprognosticindex)低危组。治疗前ECOGPS(performancestatus)评分0～1的患者占总数的92%,贫血见于26%的患者,而53%的患者伴随有B症状。全组患者中位生存时间27个月(95%CI:10～45个月)。单因素分析显示,性别、年龄、PS评分、乳酸脱氢酶水平、IPI、B症状、Hb(hemoglobin)浓度及白细胞数等指标与预后相关。多因素分析显示,治疗前Hb<110g/L、有B症状及PS评分>1是鼻型NK/T细胞淋巴瘤患者的不良预后因素。治疗模式的选择对患者的预后亦产生显著影响。结论:Hb浓度、B症状及PS评分可以作为判断鼻型NK/T细胞淋巴瘤预后的参考因素。     

Clinical analysis of patients with primary and secondary extranodal natural killer/T-cell lymphoma of central nervous system

Extranodal natural killer (NK)/T-cell lymphoma (NKTL) is a rare non-Hodgkin lymphoma that rarely arise exclusively in or metastasizes to the central nervous system (CNS). Globally, CNS involvement of NKTL heralds a serious prognosis and there is no standard treatment. 19 of 414 patients (4.59%) with ENKL followed were diagnosed with CNS involvement between 2006 and 2020. Two patients had primary CNS (PCNS) NKTL, and 17 patients had secondary CNS (SCNS) invasion. A total of 9 patients survived and 10 patients died. The median overall survival time was 55 months, and the median survival time after CNS invasion was 17 months. The 5-year cumulative survival probability was 45.7%. In conclusion, CNS risk evaluation and prophylaxis treatment can be carried out for patients with NK/T-cell lymphoma prognostic index risk group III/IV. In terms of treatment, systemic therapy based on methotrexate combined with radiotherapy and intrathecal chemotherapy can be selected.     

19例原发鼻腔非NK/T淋巴瘤的临床分析

目的:探讨原发鼻腔非NK/T淋巴瘤临床特征、治疗及预后。方法:回顾性分析1997~2004年收治的19例原发鼻腔非NK/T淋巴瘤患者的临床资料。结果:本组19例患者,中位年龄48岁(16~70岁),5年生存率为74%,单因素分析显示,影响总生存率的预后因素为化疗后是否完全缓解和有无局部复发或其它脏器累及。结论:原发鼻腔非NK/T淋巴瘤应选择化疗后放疗的综合治疗,一线化疗的疗效是影响总生存率的预后因素。     

血管免疫母细胞性T细胞淋巴瘤20例临床分析

 【摘要】　目的　分析血管免疫母细胞性T细胞淋巴瘤（AILT）的临床特点及近期疗效,为提高AILT诊治水平提供借鉴。方法　对2005年1月至2010年1月收治的20例AILT患者的临床资料进行回顾性分析,总结患者的临床及病理特点、治疗和生存情况。结果　20例AILT患者中位年龄55.9岁,均有淋巴结肿大,11例有B组症状,确诊依据淋巴结活组织检查,免疫组织化学均表达T细胞抗原CD3、CD45RO,治疗均采用以CHOP方案为主的化疗,其他治疗包括DICE、ESHAP、Hyper-CVAD方案及自体造血干细胞移植,随访5～69个月,全组中位生存期为20.2个月（5～69个月）,1、2、3年无病生存率分别为67 %、33 %、11 %,8例处于持续缓解状态,占全组的40 %,分别生存63、47、27、24、24、12、5、1个月。结论　AILT患者年龄偏大,化疗过程中并发症较多,虽然早期化疗可使患者症状有不同程度减轻,但停止治疗后容易复发,国际预后指数（IPI）对长期生存的影响非常重要,临床需要更有效的治疗方案来提高AILT的疗效。     

Extranodal NK/T-cell lymphoma, nasal type

Extranodal NK/T-cell lymphoma, nasal type (ENKTCL), previously known as lethal midline granuloma is a distinct clinico-pathological entity associated with Epstein-Barr virus that typically causes destruction of the midface, palatal and orbital walls. In addition, ENKTCL can involve the skin, soft tissue, testes, gastrointestinal and upper respiratory tract. ENKTCL neoplastic cells express some T-cell associated antigens, most commonly CD2 and cytoplasmic CD3epsilon and, in favour of an NK-cell origin, CD56. Early stage disease may respond to radiotherapy alone, however late stage disease does not respond well to any available therapies. Overall, patients with ENKTCL have a cumulative probability of survival at 5 years ranging from 37.9% to 45.3%.     

Extranodal natural killer/T-cell lymphoma, nasal type: the significance of radiotherapeutic parameters

BACKGROUND: The objective of this study was to investigate the correlation between local recurrence and radiotherapeutic parameters, including dose and RT radiotherapy (RT) field. METHODS: The current study included 35 patients who were diagnosed with immunohistochemically confirmed nasal natural killer (NK)/T-cell lymphoma between 1976 and 2004. There were 21 males and 14 females, and they ranged in age from 18 years to 76 years (median, 51 yrs). The primary tumor originated in the nasal cavity in 28 patients, and 32 patients had Stage I disease. Seventeen patients received treatment solely with RT, and the remaining 18 patients received a combination of chemotherapy and RT. The median tumor dose was 50 grays (Gy) (range, 22-60 Gy). Twenty-seven patients received RT to include all macroscopic lesions, all paranasal sinuses, the palate, and the nasopharynx. Eight patients received RT to all macroscopic lesions with generous margins. RESULTS: A complete remission (CR) or a CR/unconfirmed was achieved in 28 patients (80%). The 5-year overall survival (OAS) rate, disease-free survival (DFS) rate, and local control probability (LCP) were 47.3%, 42.9%, and 65.2%, respectively. Patients who received RT only to macroscopic lesions fared less well in terms of LCP (LCP 5 years, 71.9% vs. 41.7%; P=0.007). The difference in RT field also affected both the OAS rate and the DFS rate. Patients who received RT doses>or=50 Gy tended to achieve favorable local control. CONCLUSIONS: In the management of nasal NK/T-cell lymphoma, the RT field affected treatment outcomes. RT doses>or=50 Gy resulted in favorable local control.     

鼻腔及鼻咽部NK／T细胞淋巴瘤的临床病理分析

目的观察鼻咽和鼻腔部位NK/T淋巴瘤的临床病理学特点和免疫组化表型,为诊断和鉴别诊断提供资料.方法组织病理学观察结合免疫组织化学染色(S-P法).结果 NK/T淋巴瘤组织结构特点为多形性淋巴细胞增生,大片的凝固性坏死和血管浸润,免疫组化表达CD3、CD45和CD56阳性.结论 NK/T淋巴瘤是与EB病毒感染有关的原发性肿瘤,结合组织学特点和免疫组化表型可以做出正确诊断.     

外周血绝对单核细胞计数、血小板与绝对淋巴细胞计数比值在原发鼻腔NK/T细胞淋巴瘤中的预后分析

背景与目的:NK/T细胞淋巴瘤(natural killer/T-cell lymphoma,NKTCL)为恶性淋巴瘤中较少见的一种类型,其在临床表现及整体疗效上差别较大,目前尚无确切的危险分层指导预后.该研究旨在探索治疗前外周血绝对单核细胞计数(absolute monocyte count,AMC)、血小板与绝对淋巴细胞计数比值(platelet-lymphocyte ratio,PLR)在原发鼻腔NKTCL预后中的意义,为患者提供更确切的危险分层,从而选择恰当的治疗方案改善预后.方法:收集天津医科大学肿瘤医院2008年1月—2013年12月初诊的132例原发鼻腔NKTCL患者的临床资料.回顾性分析治疗前外周血AMC、PLR与患者5年总生存率(overall survival,OS)及无进展生存率(progression-free survival,PFS)之间的关系.患者预后的影响因素采用单因素分析和Cox比例风险模型多因素分析.结果:治疗前外周血AMC、PLR在原发鼻腔NKTCL患者的预后分层中均具有重要作用.AMC小于0.5×109个/L组患者的预后明显优于AMC大于等于0.5×109个/L组,PLR小于150组患者的预后优于PLR大于等于150组(P<0.05).根据分期、ECOG评分标准、AMC、PLR这4个独立危险因素,我们试图建立了一个新的预后模式,将所有患者分为3个不同危险组,结果发现3个组的5年OS及PFS差异有统计学意义(P<0.05).结论:外周血AMC、PLR与原发鼻腔NKTCL患者的预后明显相关.由分期、ECOG评分标准、AMC、PLR这4个独立危险因素组成的新的预后模式可能较国际预后指数(International Prognostic Index,IPI)及韩国预后指数(Korean Prognostic Index,KPI)更确切方便、更经济实用.     

Treatment outcome of radiotherapy alone versus radiochemotherapy in early stage nasal natural killer/T-cell lymphoma

This study aims to investigate the prognostic factors and long-term treatment outcome in patients with early stage nasal natural killer (NK)/T-cell lymphoma. Sixty-four patients were recruited in this study, whose clinical and laboratory data were collected from hospital records. Early stage (stage IE: 51, stage IIE: 13) nasal NK/T-cell lymphoma (NNTCL) was established according to Ann Arbor staging classification. Among these patients, 23 received radiotherapy (RT) alone, the remaining 41 cases were treated with radiochemotherapy (RCT) comprised of 1–6 cycles of anthracycline-based chemotherapeutic regimens. Results show that the median overall survival (OS) time was 41 months. The 5-year OS and progression-free survival rates were 59.2 and 52.3%, respectively. The 5-year OS rate for patients who received RT alone was 57.9%, whereas that for patients who received RCT was 61.5% (P = 0.47). There is no significant difference between two treatment modalities. Multivariate analysis showed that Eastern Cooperative Oncology Group performance status (PS) score ≥ 2, local tumor invasion out of nasal cavity, and lower complete remission (CR) rates in the initial treatment were significant unfavorable independent prognostic factors. Taken together, our study suggests that RCT did not improve the survival rate of patients with early stage NNTCL. PS score before treatment, local tumor invasion out of nasal cavity, and CR rate of the primary treatment may be independent prognostic factors among the subtype lymphoma entity.