鼻型NK/T细胞淋巴瘤的临床和预后分析

Clinical features and prognosis of nasal type NK/T cell lymphoma

目的分析鼻型NK/T细胞淋巴瘤的临床特点、治疗方法和预后情况,并探讨其疗效的改进。方法39例患者多数做了化放综合治疗,化疗主要为含蒽环类的CHOP或类似方案,中位5个周期。放射治疗采用高能光子射线配合高能电子线,常规分割,中位根治剂量56Gy。对临床资料进行双变量相关分析和单因素生存分析。结果39例患者中,存活患者21例,其中位随访时间22.5个月。首程治疗后总缓解率66.7%(21例完全缓解,3例部分缓解),单纯化疗完全缓解率37.5%。全组肿瘤局部控制率59.5%,根治性放疗的局部失败率25.0%,放射治疗与局部控制(P=0.000)、疾病进展时间(TTP,P=0.002)呈正相关。治疗失败的结外部位还包括皮肤和肠道,15例患者病程急骤,中位生存5个月。生存分析显示,生存有利的预后因素包括放射治疗(P=0.001)、国际预后指数(IPI)低危(P=0.001)、首程治疗完全缓解(P=0.000)、病史>2个月(P=0.024)和无皮肤浸润(P=0.034)。结论此型淋巴瘤确诊时多为早期病变,放射治疗是重要的治疗手段。放化综合治疗对进展期患者的疗效尚待改进。部分患者病程急骤、预后不良,需要进一步的研究以确定新的预后监测指标和个体化治疗方案。

Objective To investigate the clinical features, treatment modalities and the prognosis of nasal type NK/T cell lymphoma. Methods The data of 39 such patients treated from June 2000 to December 2003 were retrospectively reviewed. Twenty three patients were treated by combined chemoradiotherapy, basing on anthraeycline-containing CHOP or similar regimens （median 5 cycles）. Eleven patients by chemotherapy alone, 2 by radiotherapy alone and 2 aged patients by palliative chemotherapy or radiotherapy. Radiotherapy was given by high energy photon ray combined with electron beam with a median curative dose of 56Gy in conventional fractionation. Bivariate correlations and univariate prognostic factors were analyzed. Results Median follow-up time for the 21 patients who were still alive was 22.5 months. The overall remission rate （RR） after initial treatment was 66. 7% （21 CR, 3 PR）. Chemotherapy alone got a CR rate of only 37.5%. The overall local control rate was 59.4%. Local relapse rate after curative radiotherapy was 25.0%. Radiotherapy was positively correlated with local control （ P = 0.000） and time to disease progression （TTP, P = 0. 002）. Skin and intestine were among the extranodal relapse sites. Fifteen patients had highly aggressive tumors with a median survival time of only 5 months. Univariate analysis showed that significant favorable survival prognostic factors were： radiotherapy （ P = 0.001 ） ; lower risk International Prognostic Index （ IPI, P = 0. 001 ） ; complete remission after primary treatment （ P = 0. 000） ; pre-diagnostic history 〉 2 months （ P = 0.024） ; and free of skin involvement （ P = 0. 034）. Conclusion Most of nasal type NK/T cell lymphoma are in early stage when diagnosed. Radiotherapy remains to be the mainstay of treatment. Combined chemoradiotherapy needs further improvement for the progressive disease type. Some patients may have highly aggressive tumors with poor prognosis. Optimal prognostic factors and individualized treatment regimens need to be investigated.