早期结外NK/T细胞淋巴瘤的预后分析

目的 分析早期上呼吸消化道结外NK/T细胞淋巴瘤(UADT ENKTCL)放疗联合以门冬酰胺酶/培门冬酶为主的化疗疗效及预后因素。方法 收集2003—2020年间贵州省肿瘤医院收治的 267例早期UADT ENKTCL患者,其中放疗或联合门冬酰胺酶/培门冬酶为主要方案化疗的 229例,单纯放疗或化疗的 38例。Kaplan-Meier计算总生存(OS)、无进展生存(PFS)并log-rank法检验和单因素分析,Cox模型多因素分析。结果 全组 5年OS、PFS分别为67.2%、61.5%;放化综合治疗、单纯放疗、单纯化疗的 5年OS分别为71.7%、35%、49%(P<0.001),5年PFS分别为66%、35%、28%(P<0.001)。放化疗患者基于NRI危险分层分为预后良好、预后不良组,5年OS分别为93.3%、64.3%(P<0.001),5年PFS分别为91.1%、56.7%(P<0.001);放疗剂量≥50Gy、<50Gy组 5年OS分别为72.4%、55.7%(P<0.001),5年PFS分别为68.3%、36.5%(P<0.001)。预后不良组化疗周期数≥4个、<4个的 5年OS分别为65.5%、59.2%(P=0.049),5年PFS分别为60.7%、50.6%(P=0.018)。单因素分析显示Ⅱ期、ECOG≥2分、超腔、单纯放疗、NRI≥1分、EB病毒-DNA≥2750 copies/ml、放疗剂量<50Gy,化疗周期数<4个为 5年OS及PFS的预后不良因素(均 P<0.05);CHOP类化疗方案仅为PFS的预后不良因素(P<0.05)。多因素分析显示超腔、ECOG≥2分、放疗剂量<50Gy均为OS和PFS的预后不良因素(均 P<0.05),Ⅱ期为OS的预后不良因素(P<0.05)。结论 早期低危UADT ENKTCL预后良好;足够剂量的扩大受累野放疗是早期UADT ENKTCL根治性手段;综合治疗较单纯放疗能改善早期预后不良组患者的预后;足疗程化疗能显著改善预后不良组的远期生存,门冬酰胺酶为基础的化疗均能较好的改善早期UADT ENKTCL的预后。

Prognostic analysis of early stage extranodal natural-killer/T cell lymphoma

Objective To analyze the efficacy and prognostic factors of radiotherapy combined with asparaginase/peaspartase-based chemotherapy regimen in the treatment of early stage extranodal natural-killer/T cell lymphoma of the upper aerodigestive tract (UADT ENKTCL). Methods 267 early stage UADT ENKTCL patients were treated in Guizhou Cancer Hospital from October 2003 to February 2020. Among them, 229 patients received radiotherapy or radiotherapy combined with menpartaminase/permenidase-based chemotherapy regimen and 38 patients were treated with radiotherapy or chemotherapy alone. The overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan-Meier method, log-rank test was conducted for univariate analysis and Cox regression model was performed for multivariate analysis. Results The 5-year OS and PFS were 67.2% and 61.5% in all patients. The 5-year OS and PFS in patients treated with radiotherapy combined with chemotherapy, radiotherapy alone and chemotherapy alone were 71.7%, 35% and 49%(allP<0.001), and 66.4%, 35% and 28%(allP<0.001), respectively. According to the NRI risk stratification, 246 patients treated with radiotherapy and chemotherapy were divided into the favourable and the unfavourable prognosis groups. The 5-year OS was 93.3% and 64.3%(P<0.001) and the 5-year PFS was 91.1% and 56.7%(P<0.001) in two groups. For patients receiving radiotherapy with a dose ≥50Gy and<50Gy, the 5-year OS was 72.4% and 55.7%(P<0.001), and the 5-year PFS was 68.3%,and 36.5%(P<0.001). In the unfavourable prognosis group, the 5-year OS of patients receiving ≥ 4 and<4 cycles of chemotherapy was 65.5% and 59.2%(P=0.049), and the 5-year PFS was 60.7% and 50.6%(P=0.018). Univariate analysis showed that stage Ⅱ, ECOG≥2, primary tumor invasion, radiotherapy alone, NRI≥1(Nomogram-revised risk index), EBV-DNA≥2750 copies/ml, radiotherapy dose < 50Gy, and<4 cycles of chemotherapy were associated with unfavorable 5-year OS and PFS (allP<0.05),and CHOP-like regimen was the risk factor of unfavorable 5-year PFS (P<0.05). Multivariate analysis demonstrated that primary tumor invasion, ECOG≥2, and radiotherapy dose <50Gy were associated with unfavorable OS and PFS (allP<0.05), and stage Ⅱ was the risk factor of unfavorable 5-year OS (P<0.05). Conclusions The prognosis of early stage low-risk UADT ENKTCL of is favourable. Sufficient dose of extended involved-field radiotherapy is an important curative modality in early stage UADT ENKTCL. Compared with radiotherapy alone, radiotherapy combined with chemotherapy can significantly improve the prognosis of early stage UADT ENKTCL patients in the unfavourable prognosis group. Full-course chemotherapy can significantly prolong the long-term survival in the unfavorable prognosis group. The chemotherapy containing asparaginase can significantly enhance the prognosis of patients with early stage UADT ENKTCL.