早期结外鼻型NK/T细胞淋巴瘤疗后远处淋巴结转移的临床特征

目的 分析 Ⅰ_E~Ⅱ_E期原发上呼吸消化道NK/T细胞淋巴瘤(UADT-NKTCL)经治疗后远处淋巴结转移率及危险因素。方法 1979—2012年共收治 468例Ⅰ_E~Ⅱ_E期UADT-NKTCL患者,其中 170例接受单纯放疗、19例单纯化疗、278例综合治疗、1例抗炎治疗。采用Kaplan-Meier法计算远处淋巴结转移率。结果 中位随访35个月,32例出现远处淋巴结转移,绝对转移率为6.8%(32/468),占总失败病例数的19.8%(32/162),2年远处淋巴结累积转移率为6.4%。71.9%(23/32)合并远处器官转移。最常见转移部位是腹腔淋巴结。单因素分析显示肿瘤原发于鼻腔外上呼吸消化道、Ⅱ_E期、首程治疗疗效未达CR者是远处淋巴结转移的高危因素。多因素分析显示 Ⅱ_E期和首程治疗疗效未达CR是远期复发的独立危险因素,危险度分别为2.82(1.37~5.82,P=0.005)和3.01(1.16~7.78,P=0.023)。Ⅱ_E期综合治疗组的远处淋巴结转移率显著低于单纯放疗组、单纯化疗组,2年远处淋巴结累积转移率分别为12.5%、35.1%、50.0%(P=0.011)。结论 早期UADT-NKTCL治疗后远处淋巴结转移率较低,但对于 Ⅱ_E期和首程疗效未达CR者转移率仍较高。Ⅱ_E期患者建议采用综合治疗以降低远处淋巴结转移率。

Clinical features of distant lymph node metastasis in early-stage extranodal nasal-type NK/T-cell lymphoma after treatment

Objective To analyze the incidence and risk factors for distant lymph node metastasis in stage Ⅰ_E and Ⅱ_E upper aerodigestive tract natural killer (NK)/T-cell lymphoma (UADT-NKTCL) after treatment. Methods From December 1979 to December 2012, 468 patients with stage Ⅰ_E and Ⅱ_E UADT-NKTCL were treated;170 patients were treated with radiotherapy alone, 19 patients with chemotherapy alone, 278 patients with radiotherapy and chemotherapy, and one patient with anti-inflammation therapy. The incidence of distant lymph node metastasis was calculated by the Kaplan-Meier method. Results The median follow-up was 35 months. Thirty-two patients had distant lymph node metastasis, accounting for 6.8% of all patients and 19.8% of 162 patients who had disease progression or recurrence;the 2-year incidence of distant lymph node metastasis was 6.4%. Twenty-three (71.9%) of the 32 patients had distant organ metastasis. Mesenteric lymph nodes were most affected in distant lymph node metastasis. The univariate analysis showed that extranasal UADT-NKTCL, stage Ⅱ_E, and not achieving a complete response (non-CR) after the first course of treatment were high-risk factors for distant lymph node metastasis. The multivariate analysis showed that stage Ⅱ_E and non-CR after the first course of treatment were identified as independent risk factors for long-term recurrence, with hazard ratios of 2.82(1.37—5.82, P=0.005) and 3.01(1.16—7.78, P=0.023). For patients with stage Ⅱ_E disease, those receiving combined-modality therapy had a significantly lower incidence of distant lymph node metastasis than those receiving radiotherapy alone and chemotherapy alone (2-year incidence of distant lymph node metastasis:12.5% vs 35.1% and50.0%, P=0.011). Conclusions The incidence of distant lymph node metastasis is low in patients with stage Ⅰ_E and Ⅱ_E UADT-NKTCL after treatment. However, the patients with stage Ⅱ_E disease or non-CR after the first course of treatment still have a high risk of distant lymph node metastasis. Patients with stage Ⅱ_E UADT-NKTCL should be treated by combined-modality therapy to reduce the incidence of distant lymph node metastasis.