原发韦氏环弥漫性大B细胞与结外鼻型NK／T细胞淋巴瘤的临床特征和预后比较

Comparison of clinical characteristics and prognoses between primary Waldeyer＇s ring diffuse large B-cell lymphoma and extranodal nasal-type NK/T-cell lymphoma

目的比较原发韦氏环弥漫性大B细胞淋巴瘤（DLBCL）与结外鼻型NK／T细胞淋巴瘤（ENKTCL）的临床特征和预后差异。方法对2000--2008年间本院收治的122例DLBCL和44例ENKTCL进行回顾分析。DLBCL通常4—6周期CHOP方案化疗后加累及野放疗，早期NKTCL单纯扩大野放疗或加辅助化疗或放疗前加短周期（1—3周期）CHOP方案化疗。Kaplan—Meier法计算生存率并Logrank检验组间差异和单因素预后分析。结果随访率为82％，DLBCL和ENKTCL随访时间满5年者分别为32例和15例。DLBCL多见于扁桃体并伴有颈淋巴结累及，ENKTCL多见年轻男性、鼻咽Ⅰ期病变、B症状和侵犯周围结构。DLBCL和ENKTCL的5年总生存率、无进展生存率分别为74％、67％和68％、59％（X^2=0．53、1．06，P=0．468、0．303）；Ⅰ＋Ⅱ期的5年总生存率、无进展生存率分别为79％、76％和72％、62％（x^2=1．20、2．46，P=0．273、0．117）。单因素分析显示年龄〉60岁、乳酸脱氢酶升高、东部肿瘤协作组评分〉1、国际预后指数评分≥1、Ⅲ＋Ⅳ期病变和大肿块与DLBCL的预后相关（X^2=9．40、12．72、6．15、10．36、12．48、5．53，P=0．002、0．000、0．013、0．001、0．000、0．019），而国际预后指数评分≥1和年龄〉60岁与ENKTCL的预后相关（x^2=3．98、8．41，P=0．046、0．004）。结论原发韦氏环的DLBCL与ENKTCL临床特征不同，但不同治疗原则下两者预后相似。

Objective This study aimed to compare the clinical characteristics and prognoses of primary Waldeyer＇s ring diffuse large B-cell lymphoma （DLBCL） and extranodal nasal-type NK/T-cell lymphoma （ENKTCL）. Methods From 2000 to 2008, 122 patients with primary Waldeyer＇s ring DLBCL and 44 patients with primary Waldeyer＇ s ring ENKTCL consecutively diagnosed were retrospectively compared. Patients with DLBCL usually received 4 -6 cycles of CHOP-based chemotherapy followed by involved-field radiotherapy. Patients with early stage ENKTCL usually received extended-field radiotherapy with or without subsequent chemotherapy, or short courses （ 1 - 3 cycles） of chemotherapy followed by radiotherapy. Kaplan-Meier method was used for survival analysis. Logrank method was used for univariate analysis. Results The follow-up rate was 82%. The number of patients followed 5 years were 32 and 15 in DLBCL and ENKTCL DLBCL mainly presented with stage II tonsillar disease with regional lymph node involvement . ENKTCL occurred predominately in young males , as nasopharyngeal stage I disease with B symptoms and involving adjacent structures. The 5-year overall survival （OS） and progression-free survival （PFS） rates were 74% and 67% in DLBCL, and 68% and 59% in ENKTCL （X2 =0.53,1.06, P =0. 468,0. 303） , respectively. In stage I and II diseases, the 5-year OS and PFS rates were 79% and 76% for DLBCL compared to 72% and 62% for ENKTCL （X2=1.20,2.46,P=0.273,0.117）. On univariate analysis, age 〉 60 years, elevated lactate dehydrogenase, eastern cooperative oneology group performance status 〉 1, international prognosis index （ IPI ） score t〉 1, stage Ill/IV diseases and bulky disease were associated with unfavorable survival for DLBCL （ X2 = 9.40,12.72,6. 15,10. 36,12.48,5.53, P =0. 002,0. 000,0. 013,0. 001,0. 000,0. 019）, and only age 〉60 years and IPI score ≥1 were associated with poor survival for ENKTCL （ X2 = 3.98,8.41,P = 0. 046,0. 004）. Conclusions These results indicate that remarkable clinical disparities exist between DLBCL and ENKTCL in Waldeyer＇s ring. Different treatment strategies for each Can result in similarly favorable prognoses.