化疗与序贯放化疗治疗鼻型结外NK／T细胞淋巴瘤的疗效比较

Curative effect of nasal type extranodal NK/T-cell lymphoma by sequential chemotherapy combined radiotherapy compared with chemotherapy

目的:探讨化疗与序贯放化疗治疗鼻型结外NK/T细胞淋巴瘤的疗效。方法:57例经病理形态学及免疫组织化学检查确诊的鼻型结外NK/T细胞淋巴瘤患者,随机分为化疗组和放化疗组。化疗组23例患者交替应用CHOP方案、VDLP方案和MEOP方案各2个疗程后进入临床观察;放化疗组34例患者除上述化疗外,均应用直线加速器进行原发部位的三维适形放疗。结果:①治疗结束时,化疗组治疗总有效率为87.0%,放化疗组总有效率为91.2%,2组差异无统计学意义(P>0.05);②2组患者随访1年的总有效率分别为73.9%和76.5%,2组仍无明显差异(P>0.05);③2组患者随访3年和5年的无病生存率分别为61.3%,47.6%和43.5%,21.4%,差异均有统计学意义(P<0.05);④治疗模式与长期生存密切相关;⑤发热、消瘦、盗汗等全身症状、中晚期(Ⅲ、Ⅳ期)、国际预后指数、功能状态评分均与预后相关,且均为独立的预后因素。结论:序贯放化疗治疗鼻型结外NK/T细胞淋巴瘤较单纯化疗疗效明显,可以显著改善长期生存率。

Objective：To explore the curative effect of nasal type extranodal NK/T-cell lymphoma by sequen- tial chemotherapy combined radiotherapy compared with chemtherapy. Method： Fifty-seven cases of nasal type ex- tranodal NK/T-cell lymphoma confirmed by pathological morphology and immuno-histochemistry were divided into chemotherapy combined radiotherapy group（34 cases） or chemotherapy group（23 cases）. Twenty-three patients in the chemotherapy group alternately applied CHOP, VDLP and MEOP regimen after each two treatments into the clinical observation; Chemotherapy combined radiotherapy group of 34 patientsm, in addition to the above chemo- therapy, applied three-dimensional conformal radiation therapy of the primary site by linear accelerators. Then all of patients were ceased treatment and followed up 3--5 years. Result： ①After treatment, effective rate of two groups was 91.2 % and 87, 0 %, there was no obvious difference（P〉0.05） ;②After follow up about 1 year, effective rate of two groups was 76.5% and 73.9%, there was no obvious difference（P〉0.05） ;③After follow up a- bout 3 years and 5 years, disease free survival（DFS） of two groups was 61.3% ,47.6% and 43.5% ,21.4%, there was obvious difference（P〈0.05）. ④ Long-term survival is closely related to treatment mode. ⑤B symptoms, ad- vanced （Ⅲ , IV） stage, the International Prognostic Index（IPI）, KPS scores were correlated with prognosis, and were independent prognostic factors. Conclusion：Treatment with chemotherapy and radiotherapy for nasal type ex- tranodal NK/T-cell lymphoma had obvious curative effect and may improve long-term survival efficiently compared with chemothera!~v alone.