早期结外鼻型NK／T细胞淋巴瘤治疗后淋巴结失败患者的预后分析

目的分析Ⅰ-Ⅱ期原发上呼吸消化道NK／T细胞淋巴瘤（UADT—NKTCL）治疗后淋巴结失败患者的生存和预后因素。方法1988年4月至2012年12月40例Ⅰ-Ⅱ期UADT—NKTCL患者在接受治疗后的随访中出现了淋巴结失败，对失败后的生存和预后进行分析。采用Kaplan—Meier法计算生存率。结果40例患者中，8例单纯区域淋巴结失败，26例单纯远处淋巴结失败，6例同时合并区域和远处淋巴结失败。57．1％（8／14）的患者区域淋巴结失败合并局部复发，71．9％（23／32）的患者远处淋巴结失败合并远处器官失败。全组患者淋巴结失败后中位生存时间为8．7个月，2年总生存率29．8％。预后分析显示，淋巴结失败时患者B症状和美国东部肿瘤协作组（ECOG）评分是预后因素。有B症状的患者中位生存时间为6．6个月，而无B症状的患者为16．3个月，两者差异有统计学意义（P=0．034）。ECOG评分0～1分的患者中位生存时间显著长于ECOG评分1〉2分的患者，分别为31．6个月和4．1个月（P〈0．001）。综合治疗的预后显著优于单纯化疗，2年生存率分别为68．6％和15．0％（P〈0．001）。结论早期UADT-NKTCL治疗后出现淋巴结失败的患者总体预后差，挽救性综合治疗可取得较好效果。

Prognosis of lymph node failure patients after treatment for early stage extranodal nasal-type NK/T-cell lymphoma

Objective To evaluate the survival and prognostic factors of patients with lymph node failure after treatment for early stage upper aerodigestive tract NK/T-cell lymphoma （UADT-NKTCL）. Methods Between April 1988 and December 2012, 40 patients with I and 1I UADT-NKTCL who developed lymphatic failure after treatment were reviewed. Survivals were estimated using the Kaplan-Meier method. Results Of 40 patients, 8 patients developed regional lymphatic failure, 26 patients developed distant lymphatic failure, and 6 patients had both regional and distant lymphatic failure. 57.1% （8/14） patients with regional lymphatic failure also had local relapse, and 71.9 % （23/32） patients with distant lymphatic failure had distant extranodal failure. The 2-year overall survival （OS） rate after lymphatic failure was 29.8 %, with a median survival of 8.7 months. B symptoms and ECOG status after lymphatic failure were prognostic factors. The median survivals of patients with or without B symptoms were 6.6 months and 16.3 months （P = 0.034）, respectively. The patients with good status （ECOG score = 0-1） after lymphatic failure had better median survivals than those with poor status （ECOG score ~〉2） （31.6 months vs 4.1 months, P 〈 0.001）. In addition, patients who received salvage combined modality therapy had better OS than received salvage chemotherapy alone, with the 2-year OS rates of 68.6 % and 15.0 % （P 〈 0.001）, respectively. Conclusions Early stage UADT-NKTCL patients with lymphatic failure has poor prognosis. Salvage combined-modality therapy could achieve better outcome.