早期结外鼻型NK/T细胞淋巴瘤疗后远期复发因素分析

目的 分析Ⅰ_E~Ⅱ_E期上呼吸消化道NK/T细胞淋巴瘤(UADT-NKTCL)经治疗后无瘤生存超过5年患者的远期复发率及危险因素。
方法 1983-2007年共114例Ⅰ_E~Ⅱ_E期UADT-NKTCL患者疗后5年内无瘤生存,其中32例单纯放疗、80例化放疗、2例单纯化疗。采用Kaplan-Meier方法计算复发率并Logrank检验及危险因素的单因素分析,Cox模型进行多因素分析。
结果随访率100%,随访时间满10年者79例。全组5年后复发12例(10.5%),复发中位时间8.2年(5.1~23.1年)。复发者中50%出现局部区域复发而无远处器官或淋巴结受累。全组10年肿瘤特异生存率和累积远期复发率分别为92.2%和8.4%。单因素分析显示初诊时有全身症状、ECOG评分≥2分、单纯化疗、初治时放疗剂量<50 Gy是远期复发因素(χ²=4.00~11.14,P=0.004~0.045),多因素分析显示初诊存在全身症状是远期复发危险因素[HR=4.74(95%CI=1.33~16.94),χ²=5.73,P=0.017]。
结论 早期UADT-NKTCL疗后5年内无瘤生存者仍有部分会出现复发。初诊时全身症状是UADT-NKTCL远期复发的独立危险因素。

Analysis of risk factors for late relapse in early-stage extranodal nasal-type NK/T-cell lymphoma after treatment

Objective To analyse the late relapse rate of stage Ⅰ_E and Ⅱ_E upper aerodigestive tract natural killer/T-cell lymphoma (UADT-NKTCL) in patients with a disease-free survival (DFS) of at least 5 years after treatment and the risk factors for late relapse. Methods Between January 1983 and October 2007, 114 patients with stage Ⅰ_E and Ⅱ_E UADT-NKTCL received radiotherapy, chemoradiotherapy, or chemotherapy and had a DFS of at least 5 years after treatment. Of the 114 patients, 32 received radiotherapy alone, 80 received chemoradiotherapy, and 2 received chemotherapy alone. The Kaplan-Meier method was used to calculate the relapse rate, and the logrank test was used for survival difference analysis and univariate analysis of risk factors;the Cox regression model was used for multivariate analysis. Results
The follow-up rate was 100%.The number of patients followed-up were 79 at 10 years time. Twelve patients had late relapse (10.5%). 50%(6/12) patients with late relapse developed first locoregional relapse without systemic failure. The 10-year cancer-specific survival and cumulative probabilities of late relapse for entire patients were 92.2% and 8.4%, respectively. In univariate analysis, B symptoms, ECOG≥2,chemotherapy alone and the dose of RT<50 Gy were risk factors to incidence of late relapse (χ²=4.00－11.14,P=0.004－0.045). In multivariate analysis, B symptom was identified as independent correlative factor to incidence of late relapse (HR=4.74(95%CI=1.33－16.93), χ²=5.73,P=0.017). Conclusions Relapse occurs in a small proportion of patients with early-stage UADT-NKTCL who have a DFS of at least 5 years. Systemic symptoms at initial diagnosis is the independent risk factor for late relapse in UADT-NKTCL.