结外NK/T细胞淋巴瘤202例临床分析

本研究通过对202例结外NK/T细胞淋巴瘤分子生物学特征、治疗及预后状况分析,探讨该病的治疗策略及其预后影响因素.对2005年至2013年我院收治的202例结外NK/T细胞淋巴瘤患者临床及基因异常、治疗及预后状况进行了回顾分析.以Ann Arbor分期、B组症状、国际预后指标（IPI）、乳酸脱氢酶（LDH）、β2微球蛋白及MYC、HXO11、BCL-2基因表达作为研究参数,运用Kaplan-Meier方法进行生存分析,并采用COX回归分析模型进行预后的多变量分析.结果表明,全部病例5年的总生存（overall-survival,OS）率与无事件生存（event-free survival,EFS）率分别为61.9％和53.9％;采用放-化疗综合治疗的患者与使用单纯化学疗法的患者相比,OS率及EFS率均显著提高,两者比较有显著差异（P＜0.05）;携带BCL-2基因表达将明显降低患者的OS率和EFS率,该结果有统计学差异（P ＜0.05）;COX回归分析模型多变量分析显示,Ann Arbor分期、BCL2基因高表达是独立的预后影响因素.结论：放-化疗综合治疗方法明显优于单纯化疗方法;Ann Arbor分期、BCL-2表达是结外NK/T细胞淋巴瘤独立的预后影响因素.

Clinical Analysis of 202 Cases of Extranodal NK/T-Cell Lymphoma

This study was purposed to explore the therapeutic strategy and factors influencing prognosis through the analysis of clinical characteristics, genetic aberrations, treatment and prognosis of the patients with extranodal NK/T cell lymphoma （ENKTL）. A total of 202 patients with ENKL from 2005 -2013 were analyzed retrospectively in term, of Ann Arbor stage, B symptoms, lactate dehydrogenase （LDH）, international prognostic index （IPI）, 132-microglobulin and the expression of MYC, HX011, BCL-2. The survival was analyzed using Kaplan-Meier method, and the COX regression model was employed for multivariate analysis. The results showed that the 5 year overall survival （OS） rate and event-free survival （EFS） rate were 61.9 % and 53.9 % respectively; chemoradiotherapy was apparently better than chemotherapy alone for OS and EFS; OS and EFS of the patients with BCL-2 expression were apparently better than patients without BCL-2 expression; multivariant analysis by COX regression showed that Ann Arbor stage and BCL-2 expression were independent prognostic factors for EFS/OS. It is concluded that chemoradiotherapy is better than chemotherapy alone for treatment of ENKL. Ann Arbor stage and BCL-2 expression are independent prognostic factors.