130例鼻腔和韦氏环NK／T细胞淋巴瘤放化疗预后分析

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

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。AnnArbor分期IE期116例、ⅡE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％，IE、ⅡF期的分别为88．8％、92．9％（X2=0．02，P=0．837），单纯放疗、放化疗联合的分别为86％、96％（X2=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％，IE、ⅡE期患者5年OS分别为60．6％、36．3％（X2=0．25，P：0．615），5年DFS分别为59．7％、36．3％（X2=0．21，P=0．648）；单纯放疗、放化联合的5年OS分别为70％、48％（X2=0．01，P=0．933），5年DFS分别为66％和48％（X2=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％（x。=41．38，P=0．002）。原发灶照射剂量（X2=3．18，P=0．005）、ECOG评分（X2=2．97，P=0．008）与OS相关。结论IE、ⅡE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。

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 IIE. 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 IIE patients were 88.8% and 92. 9%, respectively （ X2 = 0. 02, P = 0. 837 ）. The CR rates of patients receiving radiotherapy alone and patients receiving radiochemotherapy were 86% and 96%, respectively （X2 = 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 IIE patients were 60. 6% and 36. 3%, respectively （X2 = 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 （ X2 = 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 （X2 = 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 （ X2 = 0. 09, P = 0. 764 ）. The grade 3--4 toxicity rates of radiotherapy alone and radiochemotherapy were 6. 7% and 54. 1%, respectively （ X2 = 41.38, P = 0. 002 ）. The radiation dose to the primary lesion and Eastern Cooperative Oncology Group （ ECOG ） score were correlated with OS （ X2 = 3. 1 8, P = 0. 005 ; X2 = 2.97, P = 0. 008 ）. Conclusions The clinical effect of radiochemotherapy is similar to that of radiotherapy alone in the patients with stage IEand 11 E nasal and Waldeyer ring NK/T cell lymphoma, but radiochemotherapy has higher toxicity than radiotherapy alone. The radiation dose to the primary lesion and ECOG score are the influential factors for OS.