早期原发鼻腔与韦氏环NK/T细胞淋巴瘤临床特征和预后比较

目的 探讨Ⅰ_E~Ⅱ_E期原发鼻腔与原发韦氏环NK/T细胞淋巴瘤在临床特征和预后等方面的差别。方法 回顾分析1991-2011年本院初治的273例患者，其中Ⅰ_E期184例，Ⅱ_E期89例。原发鼻腔(NC-NKTL)209例和原发韦氏环(WR-NKTL)64例。258例(94.5%)患者先接受化疗，多数患者接受CHOP或类似方案化疗，放疗中位剂量为54 Gy。结果 与NC-NKTL相比，WR-NKTL中Ⅱ_E期和有B症状者显著增多。两组治疗后有效率相近(88.7%和87.9%，P=0.869)。随访率96.3%，随访时间满5年者196例。5年总生存率(OS)和无进展生存率(PFS)分别为52.6%和41.4%，其中NC-NKTL的5年OS有高于WR-NKTL的趋势(57.0%∶39.0%，P=0.062)，而5年PFS则高于WR-NKTL的(46.7%∶25.8%，P=0.019)。结论 早期原发韦氏环NK/T细胞淋巴瘤较原发鼻腔病变更易发生全身症状和颈部淋巴结转移，预后较差，临床上考虑提早放疗和颈部淋巴结预防照射。

Comparison of clinical features and prognosis between patients with early-stage NK/T-cell lymphoma originating from nasal cavity and Waldeyer's ring

Objective To investigate the differences in clinical features and prognosis between patients with stage Ⅰ_E-Ⅱ_E nasal cavity natural killer (NK)/T-cell lymphoma (NC-NKTL) and Waldeyer′s ring NK/T-cell lymphoma (WR-NKTL). Methods A retrospective analysis was performed on 273 patients with NK/T lymphoma who were initially treated in our hospital from January 1991 to December 2011. Of these patients, 184 had Ann Arbor stage Ⅰ_E disease, and 89 had stage Ⅱ_E disease;209 had NC-NKTL, and 64 had WR-NKTL. A total of 258 patients (94.5%) were first treated with chemotherapy. The majority of patients received CHOP or CHOP-like chemotherapy. The median dose of radiotherapy was 54 Gy. Results Compared with NC-NKTL patients, WR-NKTL patients had significantly higher percentages of individuals in stage Ⅱ_E and individuals with B symptoms (P<0.05 for both). The overall response rates of the two groups after treatment were similar (88.7% vs 87.9%, P=0.869). The follow-up rate was 96.3%. 196 patients were followed up for at least 5 years. The 5-year overall survival (OS) and progression-free survival (PFS) were 52.6% and 41.4%, respectively. The 5-year OS of NC-NKTL patients was nonsignificantly higher than that of WR-NKTL patients (57.0% vs 39.0%, P=0.062), while the 5-year PFS of NC-NKTL patients was significantly higher than that of WR-NKTL patients (46.7% vs 25.8%, P=0.019). Conclusions Patients with early-stage WR-NKTL are more prone to systemic symptoms and cervical lymph node metastasis and have poorer prognosis, as compared with patients with early-stage NC-NKTL, so radiotherapy and prophylactic irradiation should be considered in early stage.