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85例结外鼻型NK/T细胞淋巴瘤治疗及预后的回顾性观察
Treatment and outcomes of extranodal natural killer/T cell lymphoma, nasal type: a retrospective analysis of 85 cases
- 第三军医大学学报 2018年40卷第8期 页码：723-727
- 作者机构：
400038 重庆，陆军军医大学(第三军医大学)第一附属医院血液病中心
- 作者简介：
[陈洁平，E-mail：454785940@qq.comCHEN Jieping, E-mail:454785940@qq.com
- 基金信息：西南医院院管课题(SWH2016ZDCX440)
DOI：10.16016/j.1000-5404.201711086
中图分类号： R730.5;R733.4;R739.62收稿：2017-11-21，
修回：2018-01-15，
纸质出版：2018-04-30
- 稿件说明：
移动端阅览
徐成, 陈洁平, 田小波, 等. 85例结外鼻型NK/T细胞淋巴瘤治疗及预后的回顾性观察[J]. 第三军医大学学报, 2018,40(8):723-727.
Cheng XU, Jieping CHEN, Xiaobo TIAN, et al. Treatment and outcomes of extranodal natural killer/T cell lymphoma, nasal type: a retrospective analysis of 85 cases[J]. Journal of Third Military Medical University, 2018, 40(8): 723-727.
徐成, 陈洁平, 田小波, 等. 85例结外鼻型NK/T细胞淋巴瘤治疗及预后的回顾性观察[J]. 第三军医大学学报, 2018,40(8):723-727. DOI： 10.16016/j.1000-5404.201711086.
Cheng XU, Jieping CHEN, Xiaobo TIAN, et al. Treatment and outcomes of extranodal natural killer/T cell lymphoma, nasal type: a retrospective analysis of 85 cases[J]. Journal of Third Military Medical University, 2018, 40(8): 723-727. DOI： 10.16016/j.1000-5404.201711086.
摘要
目的
2
探讨结外鼻型NK/T细胞淋巴瘤(Extranodal NK/T-cell lymphoma，nasal type ENKL，NKTCL)的临床特征、免疫组化特征、预后评估方式、干预措施对预后的影响。
方法
2
回顾性分析2013年1月至2017年4月就诊于我中心、经病理确诊为NKTCL的85例患者的随访资料(平均年龄46.25岁，男女性别比例约2 :1)。依据Ann Arbor分期评估结果分别接受单纯放疗、单纯化疗、放化疗联合等3种不同方案的治疗，纳入临床特征、Ann Arbor分期、国际预后指数(international prognostic index，IPI)评分、ECOG(eastern cooperative oncology group)评分、EB病毒(epstein-barr virus，EBV)、乳酸脱氢酶(lactate dehydrogenase，LDH)、病理免疫组化、治疗方案等指标，运用Kaplan-Meier及多因素Cox比例风险等统计学法分析上述指标对NKTCL生存的影响。
结果
2
85例患者完全缓解率(complete response rate，CR)为41.1%，部分缓解率(partial response rate，PR)为21.1%，中位生存时间为37个月。1、3、5年的总生存率分别为68.2%、48.4%、32.7%，疾病无事件生存率(event-free survival rate，EFS)分别为56.0%、45.3%、31.8%。单因素分析结果显示：An
n Arbor分期、IPI、ECOG评分、LDH、淋巴瘤B症状、白细胞数、血红蛋白、灶性CD20、EBV等对NKTCL的预后影响有统计学意义(
P
<
0.05)；其中Ann Arbor分期、IPI评分、ECOG评分是NKTCL的独立预后因素。单纯放疗、单纯化疗、联合放化疗对生存率的影响无显著性差异(
P
>
0.05)。
结论
2
淋巴瘤B症状、高LDH、异常白细胞、低血红蛋白、灶性CD20(-)、EBV(+)与NKTCL预后相关；AnnArbor分期、ECOG、IPI评分可作为其独立预后指标。
Abstract
Objective
2
To analyze the impact of clinical features
immunohistochemical characteristics
prognostic evaluation and interventions on the outcomes of patients with nasal-type extranodal natural killer/T cell lymphoma (NKTCL).
Methods
2
This retrospective study was conducted among 85 patients (median age of 46.25 years
male/female ratio of 2 :1) with the pathological diagnosis of NKTCL treated in our center between January
2013 and April
2017. Based on Ann Arbor staging results
the patients received 3 different treatment regimens
namely radiotherapy alone
chemotherapy alone
and radiotherapy combined with chemotherapy. The impact of clinical characteristics
Ann Arbor staging
International Prognostic Index (IPI) scores
Eastern Cooperative Oncology Group (ECOG) scores
Epstein-Barr virus (EBV) positivity
lactate dehydrogenase (LDH)
pathological and immunohistochemical findings
and treatment regimens on the outcomes of the patients was analyzed using Kaplan-Meier method and multifactor Cox proportional risk analysis.
Results
2
The 85 patients had a complete response rate (CR) of 41.1% and a partial response rate (PR) of 21.1%. The median survival time of the patients was 37 months
with the 1-
3-
and 5-year overall survival rates (OS) of 68.2%
48.4% and 32.7%
and 1-
3-
and 5-year event-free survival rates (EFS) of 56%
45.3% and 31.8%
respectively. Univariate analysis showed that Ann Arbor stages
IPI scores
ECOG scores
LDH level
B symptoms
white blood cell count
hemoglobin
focal CD20 and EBV positivity wer
e significant factors affecting the prognosis of patients with NKTCL (
P
<
0.05); Ann Arbor stages
IPI scores and ECOG scores were independent prognostic factors of NKTCL. Different treatment regimens (radiotherapy
chemotherapy
either alone or in combination) did not significantly affect the outcomes of the patients.
Conclusion
2
The presence of B symptoms
a high LDH level
abnormal white blood cell count
a low hemoglobin
focal CD20 negativity and EBV positivity are all associated with the a poor prognosis of NKTCL; Ann Arbor stage
ECOG scores and IPI scores can be used as independent factors for predicting the prognosis of NKTCL.
关键词
Keywords
references
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