71例鼻腔NK／T细胞淋巴瘤放化疗效和预后因素分析

Prognostic factors and long term treatment outcome of 71 cases of nasal NK/T cell lymphoma

目的回顾性分析71例鼻腔NK／T细胞淋巴瘤患者的放化疗疗效和预后因素。方法12年余间安徽省立医院肿瘤放疗科共收治原发鼻腔NK／T细胞淋巴瘤71例，其中男40例，女31例，年龄15—80岁，中位年龄44岁。AnnArbor分期ⅠE、ⅡE、ⅢE、ⅣE期分别为51、13、1、6例。单纯放疗23例，余48例放化疗。采用Kaplan-Meier法行生存分析，单因素分析用Logrank法，多因素分析用Cox比例风险模型。结果全组死亡33例，5年总生存率为48．2％。ⅠE、ⅡE、ⅢE＋ⅣE期患者5年总生存率分别为59．O％、35．8％、0％（χ^2=42．61，P〈0．01）。单纯放疗组和放化疗组5年总生存率分别为57．9％和61．5％（χ^2=10．99，P〉0．05）。多因素回归分析表明治疗前行为状况（Ps）评分、初诊时病灶超腔、近期疗效是独立预后因素。结论放疗加CHOP方案为主的化疗未提高ⅠE＋ⅡE期患者远期生存率。治疗前PS评分、初诊时病灶超腔、近期疗效可作为判断鼻腔NK／T细胞淋巴瘤临床预后的参考指标。

Objective To retrospectively analyze the clinical characteristics and long term treatment outcomes of 71 cases of nasal natural killer （NK）/T cell lymphoma, and to explore its prognostic factors. Methods Between July 1993 and October 2005, 71 patients with nasal NK/T cell lymphoma were diagnosed pathologically, including 40 male and 31 female. The median age was 44 （range 15-80） . According to Ann Arbor staging classification, 64 patients had stage Ⅰ E or Ⅱ E disease. Twenty-three patients received radiotherapy alone and the remaining 48 received chemotherapy combined with radiotherapy. Kaplan-Meier method was used for survival analysis and Cox regression model for multivariate analysis. Results Thirtythree patients died during the follow-up, and the 5-year overall survival （OS） rate was 48.2%. For the stage Ⅰ E and Ⅱ E patients, the 5-year OS rate was 59.0% and 35.8%, respectively; For patients received radiotherapy alone and those received chemotherapy and radiotherapy, the 5-year OS rate was 57.9% and 61.5%, respectively （P 〉0.05）. Multivariate analysis showed that Eastern Cooperative Oncology Group （ECOG） performance status （PS） score ≥2, local tumor invasion and complete response rate of the primary treatment were the significant prognostic factors. Conclusions CHOP-based chemotherapy combined with radiotherapy can＇t improve the survival of patients with early stage nasal NK/T cell lymphoma. PS score ≥2 before treatment, local tumor invasion and complete response rate of the primary treatment may be the independent prognostic factors.