结外NK-T细胞淋巴瘤-鼻型临床研究

目的探讨结外NK—T细胞淋巴瘤-鼻型的诊断、误诊原因及不同治疗方法对患者预后的影响。方法回顾性比较分析68例结外NK—T细胞淋巴瘤-鼻型不同治疗组的近期疗效和1、3、5年生存率和患者的临床特征。其中，ⅠE期60例患者分为单一治疗组20例（放疗9例、化疗11例）；综合治疗组40例（放疗＋化疗9例、化疗＋放疗12例、化疗＋放疗＋化疗19例）；ⅣE期（远处受累）8例患者行单纯放疗3例，化疗＋放疗5例。结果全组误诊率为66．2％（45／68），误行手术治疗占52．9％（36／68）。IE局限组（病灶局限于一侧鼻腔）和IE超腔组（病灶超出鼻腔）完全缓解率分别为94．4％（17／18）和61．9％（26／42），差异有统计学意义（P=0．012）。全组患者1、3、5年生存率分别为79．9％、56．3％、34．2％。其中ⅠE局限组1、3、5年生存率分别为100％、77．8％、59．8％；ⅠE超腔组1、3、5年生存率分别为80．1％、48．5％、14．6％；ⅣE组1、3、5年生存率分别为17．5％、0．0％、0．0％，3组间比较差异有统计学意义（P=0．000）。20例ⅠE期单一治疗组1、3、5年生存率分别为68．4％、22．8％、7．6％；40例ⅠE期综合治疗组1、3、5年生存率分别为94．9％、81．1％、52．4％，两组间差异有统计学意义（P=0．000）；其中放＋化疗与化＋放疗及化＋放＋化疗3种方法1、3、5年生存率差异无统计学意义（P=0．088）。结论结外NK—T细胞淋巴瘤-鼻型早期临床表现不典型，易误诊误治；早期治疗是关键，以尽早达到局部控制，分期ⅠE超腔以上宜行综合治疗。

Clinical study of extranodal NK-T cell lymphoma-nasal type

OBJECTIVE: To discuss how the diagnosis, misdiagnosis and different treatment modalities affect the prognosis of the patients with extranodal NK-T cell lymphoma-nasal type. METHODS: A retrospective study was made on the clinical characteristics, treatment modality, short-term effect, and survival rate of 68 patients with extranodal NK-T cell lymphoma-nasal type. Among them,60 patients staged I(E) were subdivided into single therapy group of 20 cases( radiation therapy 9 cases, chemotherapy 11 cases) and combined therapy group of 40 cases (9 cases with radiation therapy + chemotherapy, 12 cases with chemotherapy + radiation therapy,19 cases with chemotherapy + radiation therapy + chemotherapy). Eight patients staged IV(E) included 3 cases with radiation therapy alone and 5 cases with chemotherapy and radiation therapy. RESULTS: The rate of misdiagnosis of whole group is 66. 2% (45/68), and the rate of misoperated patients accounted for 52. 9% (36/68). The CR rate of radiation therapy was 94. 4% (17/18) for limited disease in I(E) group compared 61.9% (26/42) for out-cavity disease in I(E) group, of which the difference is significant (P =0. 012). The 1-years, 3-years and 5-years survival rate of the I(E) intra-cavity group were 100%, 77.8%, 59.8%, and those of ex-cavity group were 80.1%, 48.5% and 14.6%, respectively. The 1, 3 and 5-years survival rate of IV(E) group were 17.5%, 0.0% and 0.0%. The difference of survival was significance among the above 3 groups (P = 0. 000). The 1, 3, 5-years survival rate of 60 I(E) patients with single therapy were 68.4%, 22.8% and 7.6% respectively; and that of combined therapy group were 94.9%, 81.1% and 52.4% respectively, which was significant difference (P = 0. 000). The survival difference among the radiation therapy + chemotherapy group, chemotherapy + radiation therapy group and chemotherapy + radiation therapy + chemotherapy group were not significant (P = 0.088). CONCLUSIONS: The early clinical manifestation of extranodal NK-T cell lymphoma-nasal type is not typical,which is easy to be misdiagnosed and mistreated. Early therapy is the key,which can achieve good location control. Diseased stage I(E) out-cavity and above should be treated with combined therapy.