摘要
目的探讨鼻咽原发和鼻咽受累结外鼻型NK/T细胞淋巴瘤患者的临床病理特征和预后。 方法回顾性分析2000年1月至2015年6月初治的结外鼻型NK/T细胞淋巴瘤患者的临床资料。鼻咽原发NK/T细胞淋巴瘤(鼻咽原发组)89例,鼻腔原发累及鼻咽NK/T细胞淋巴瘤(鼻咽受累组)113例,分析两组患者的临床病理特征、治疗情况和预后。采用Kaplan-Meier法和log rank检验进行生存分析。 结果鼻咽原发组和鼻咽受累组患者具有相似的临床病理特征,颈部淋巴结受侵比例均较高,分别为55.1%和42.5%(P=0.076);鼻咽原发组和鼻咽受累组患者乳酸脱氢酶升高比例分别为28.1%和41.6%,差异有统计学意义(P=0.001)。在Ⅰ~Ⅱ期患者中,鼻咽原发组和鼻咽受累组患者的5年总生存率分别为68.8%和55.7%,差异无统计学意义(P=0.168);5年无进展生存率分别为55.6%和47.2%,差异无统计学意义(P=0.241)。全组患者的5年总生存率分别为63.2%和54.6%,差异无统计学意义(P=0.291);5年无进展生存率分别为50.7%和45.6%,差异无统计学意义(P=0.310)。鼻咽原发组患者初始化疗后的完全缓解率为43.8%,高于鼻咽受累组的19.6%(P=0.006);鼻咽原发组和鼻咽受累组患者初始放疗后的完全缓解率分别为63.4%和62.7%,差异无统计学意义(P=0.629)。在Ⅰ~Ⅱ期鼻咽原发组患者中,放疗±化疗组和单纯化疗组患者的5年总生存率分别为70.5%和33.3%,5年无进展生存率分别为56.7%和33.3%,差异均无统计学意义(均P>0.05);在Ⅰ~Ⅱ期鼻咽受累组患者中,放疗±化疗组和单纯化疗组患者的5年总生存率分别为57.4%和33.3%,5年无进展生存率分别为49.3%和16.7%,差异均无统计学意义(均P>0.05)。鼻咽原发组和鼻咽受累组患者的复发进展模式相似,均以远处结外器官复发进展为主,其次为淋巴结。 结论鼻咽原发和鼻咽受累NK/T细胞淋巴瘤患者的临床病理特征和预后相似,化疗的近期疗效不同。
Objective To investigate the clinical and prognostic differences between primary nasopharyngeal natural killer (NK)/T-cell lymphoma (NP NKTCL) and extranodal NK/T-cell lymphoma of the nasal cavity with nasopharynx extension (N-NP NKTCL). Methods A total of 89 patients with NP NKTCL and 113 patients with N-NP NKTCL from January 2000 to June 2015 were retrospectively analyzed. Clinical and pathological features, treatment responses and prognosis were compared between the two groups. Results NP NKTCL patients showed similar clinicopathological features with those with N-NP NKTCL, except that the former had a relative low proportion of elevated lactate dehydrogenase (LDH) levels (28.1% vs. 41.6%;P=0.001). Both of two groups presented with high proportion of cervical lymph node involvement (55.1% and 42.5%;P=0.076). The 5-year overall survival (OS) rates in these two groups were 63.2% and 54.6%, respectively, whereas 5-year progress-free survival (PFS) rates were 50.7% and 45.6%, respectively. For the patients with stage Ⅰ and Ⅱ, the 5-year OS and PFS rates in these two groups were 68.8% and 55.7% as well as 55.6% and 47.2%, respectively. These were no statistically significant differences between two groups (all P>0.05). The complete response (CR) rate after initial chemotherapy in NP NKTCL group was 43.8%, which was significant higher than that of 19.6% in N-NP NKTCL group (P=0.006). Additionally, the CR rate after primary radiotherapy was 63.4% and 62.7%, respectively (P=0.629). The NP NKTCL patients with stage Ⅰ and Ⅱ who accepted radiotherapy with or without chemotherapy had similar survival times with chemotherapy alone, showing the 5-year OS rates of 70.5% and 33.3% (P=0.238), as well as the 5-year PFS rates of 56.7% and 33.3%, respectively (P=0.431). Similar results were found in N-NP NKTCL group, the 5-year OS rates for patients with radiotherapy with or without chemotherapy and chemotherapy alone were 57.4% and 33.3% (P=0.246), while the 5-year PFS rates were 49.3% and 16.7% (P=0.177), respectively. Besides, the relapse pattern of NP NKTCL and N-NP NKTCL groups was also similar, mainly involving the distant extra-nodal organs followed by lymph nodes. Conclusion The patients with N-NP NKTCL and NP NKTCL showed similar clinical and prognostic features, however, the initial response to chemotherapy was different.
作者
刘伟欣
刘跃平
金晶
王淑莲
房辉
任骅
宋永文
陈波
卢宁宁
李宁
唐源
亓姝楠
唐玉
王维虎
李晔雄
Liu Weixin;Liu Yueping;Jin Jing;Wang Shulian;Fang Hui;Ren Hua;Song Yongwen;Chen Bo;Lu Ningning;Li Ning;Tang Yuan;Qi Shunan;Tang Yu;Wang Weihu;Li Yexiong(Department of Radiation Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2019年第1期56-62,共7页
Chinese Journal of Oncology
基金
国家重大研发计划(2016YFC0904600)
中国医学科学院医学与健康科技创新工程经费(2016-12M-1-001).
