130例鼻腔和韦氏环NK/T细胞淋巴瘤放化疗预后分析

目的 观察鼻腔、韦氏环NK/T细胞淋巴瘤放化疗疗效,并分析影响预后的因素。
方法2000-2010年本院共收治经免疫组化确诊130例鼻腔、韦氏环NK/T细胞淋巴瘤,其中鼻腔的109例、韦氏环的21例。Ann Arbor分期Ⅰ_E期116例、Ⅱ_E期14例。单纯放疗30例,单纯化疗2例,放化疗联合98例。
结果 随访率100%,随访时间满5年者78例。完全缓解率全组为89.2%,Ⅰ_E、Ⅱ_E期的分别为88.8%、92.9%(χ²=0.02,P=0.837),单纯放疗、放化疗联合的分别为86%、96%(χ²=1.44,P=0.230)。全组5年总生存(OS)和无瘤生存(DFS)率分别为58.0%和57.2%,Ⅰ_E、Ⅱ_E期患者5年OS分别为60.6%、36.3%(χ²=0.25,P=0.615),5年DFS分别为59.7%、36.3%(χ²=0.21,P=0.648);单纯放疗、放化联合的5年OS分别为70%、48%(χ²=0.01,P=0.933),5年DFS分别为66%和48%(χ²=0.09,P=0.764)。单纯放疗、放化联合的主要3、4级不良反应总发生率分别为6.7%、54.1%(χ²=41.38,P=0.002)。原发灶照射剂量(χ²=3.18,P=0.005)、ECOG评分(χ²=2.97,P=0.008)与OS相关。
结论 Ⅰ_E、Ⅱ_E期鼻腔、韦氏环NK/T细胞淋巴瘤放化联合与单纯放疗疗效相似,但不良反应较重;原发灶照射剂量、ECOG评分是影响OS的因素。

Prognostic analysis of 130 patients with nasal and Waldeyer ring NK/T cell lymphoma treated by radiotherapy and/or chemotherapy

Objective To observe the clinical effects of radiotherapy and/or chemotherapy in the treatment of nasal and Waldeyer ring natural killer (NK)/T cell lymphoma and to analyze the prognostic factors. Methods Between January 20, 2000 and December 21, 2010, 109 patients with nasal NK/T cell lymphoma and 21 patients with Waldeyer ring NK/T cell lymphoma were admitted to our hospital;the diagnosis was confirmed by immunohistochemistry. According to the Ann Arbor staging system, 116 patients were classified as stage Ⅰ_E, and 14 as stage Ⅱ_E. Thirty patients received radiotherapy alone;2 patients received chemotherapy alone;98 patients received radiochemotherapy. Results The follow-up rate was 100%. Seventy-eight patients were followed up for at least 5 years. The complete remission (CR) rate was 89.2% in all patients. The CR rates of stage Ⅰ_E patients and stage Ⅱ_E patients were 88.8% and 92.9%, respectively (χ²=0.02, P=0.837). The CR rates of patients receiving radiotherapy alone and patients receiving radiochemotherapy were 86% and 96%, respectively (χ²=1.44, P=0.230). The five-year overall survival (OS) rate and disease-free survival (DFS) rate of all patients were 58.0% and 57.2%, respectively. The five-year OS rates of stage Ⅰ_E patients and stage Ⅱ_E patients were 60.6% and 36.3%, respectively (χ²=0.25, P=0.615);the five-year DFS rates of stage Ⅰ_E patients and stage Ⅱ_E patients were 59.7% and 36.3%, respectively (χ²=0.21, P=0.648). The five-year OS rates of patients receiving radiotherapy alone and patients receiving radiochemotherapy were 70.0% and 48.4%, respectively (χ²=0.01, P=0.933);the five-year DFS rates of patients receiving radiotherapy alone and patients receiving radiochemotherapy were 65.6% and 48.4%, respectively (χ²=0.09, P=0.764). The grade 3—4 toxicity rates of radiotherapy alone and radiochemotherapy were 6.7% and 54.1%, respectively (χ²=41.38, P=0.002). The radiation dose to the primary lesion and Eastern Cooperative Oncology Group(ECOG) score were correlated with OS (χ²=3.18, P=0.005;χ²=2.97, P=0.008). Conclusions
The clinical effect of radiochemotherapy is similar to that of radiotherapy alone in the patients with stage Ⅰ_E