局部区域复发早期结外鼻型NK/T细胞淋巴瘤挽救治疗初步预后分析

目的 回顾分析局部区域复发的早期结外鼻型NK/T细胞淋巴瘤挽救治疗预后因素。方法 按入组标准纳入1995-2014年间首次治疗后出现局部区域复发且接受了挽救治疗的早期结外鼻型NK/T细胞淋巴瘤56例,分析挽救治疗对OS、复发后OS的影响,并对复发后OS进行单因素及多因素预后分析。结果 总中位随访时间 35.9个月,3年OS率为73%。复发后中位随访时间14.8个月,3年复发后OS率为58%。挽救治疗方式中加入放疗较单纯化疗提高了OS (P=0.040)和复发后OS (P=0.009),二程放疗较单纯化疗提高了OS (P=0.018)和复发后OS (P=0.019),二程放疗的急性及晚期不良反应多为1-2级(84%)。在单因素和多因素分析中KPS评分、首治有无放疗、挽救有无放疗均对复发后OS有影响。结论 放疗是局部区域复发的结外鼻型NK/T细胞淋巴瘤挽救治疗中不可或缺手段,能改善生存且不良反应可接受。

Salvage treatment outcome and prognosis of patients with locoregionally recurrent early-stage extranodal NK/T cell lymphoma,nasal type

Objective To retrospectively analyze the prognostic factors for locoregionally recurrent early-stage extranodal nasal-type natural killer/T-cell lymphoma (NKTCL). Methods A total of 56 patients with early-stage extranodal nasal-type NKTCL, who had locoregional recurrence after initial treatment and then received salvage treatment from 1995 to 2014, were enrolled as subjects. The effects of salvage treatment on the overall survival (OS) rate were analyzed after initial treatment and recurrence. Univariate and multivariate prognostic analyses were performed on the OS rate after recurrence. Results The median follow-up time was 35.9 months after initial treatment and 14.8 months after recurrence. The 3-year OS rate was 73% after initial treatment and 58% after recurrence. Compared with chemotherapy alone, radiotherapy-containing salvage treatment significantly improved the OS rates after initial treatment and recurrence (P=0.040, 0.009), and re-irradiation also significantly improved the OS rates after initial treatment and recurrence (P=0.018, 0.019). Most (84%) of the acute and late adverse reactions after re-irradiation were grade 1-2 ones. The univariate and multivariate analyses showed that the Karnofsky Performance Status score, radiotherapy in initial treatment, and radiotherapy in salvage treatment were influencing factors for the OS rate after recurrence. Conclusions Radiotherapy achieves improved survival and tolerable toxicities, making it indispensable in the treatment of locoregionally recurrent extranodal nasal-type NKTCL.