结外NK／T细胞淋巴瘤患者影像学及临床病理特征与预后的关系

Association between radiographic and clinicopathological features and prognosis in patients withextranodal NK/T cell lymphoma

目的探讨CT及磁共振成像（MRI）在结外NK/T细胞淋巴瘤（NK/TCL）临床诊断及预后判断中的应用价值。方法选取2002年6月至2016年4月间在北京同仁医院病理科确诊同时具有完整的CT和MRI影像及临床资料的NK/TCL患者66例，回顾性分析其影像及临床病理特征，并进行预后分析。结果男性49例，女性17例，中位年龄42岁，中位随访时间18个月。病变侵犯周围组织，包括软腭10例（15.2%）、硬腭5例（7.6%）、扁桃体2例（3.0%）、上唇8例（12.1%）、颌面部软组织13例（19.7%）、眼睑9例（13.6%）、眼眶10例（15.2%）、上颌骨3例（4.5%）、翼腭窝6例（9.1%）、颞下窝6例（9.1%）、颅底3例（4.5%）、眼球3例（4.5%）及脑组织2例（3.0%）。单因素分析显示鼻窦、硬腭、上唇、颌面部软组织、眼睑、眼眶、上颌骨、眼球及脑组织受累患者的2年生存率低于未受累者（χ2值分别为4.470、4.041、4.456、13.933、8.986、4.000、44.121、6.527、16.822，均P〈0.05）；多因素分析显示上颌骨受累与脑组织受累是预后不良的独立影响因素（RR=34.717，95% CI为3.404-354.035，P=0.003；RR=37.545，95% CI为3.188-442.187，P=0.004）。结论MRI和CT检查在NK/TCL诊断及预后判断中有重要的价值。临床医生可综合临床、影像及病理特点，详细评估患者的情况，给予恰当的治疗，从而改善患者预后。

ObjectiveTo explore the CT and MRI imaging and clinicopathological features of extranodal NK/T cell lymphoma （NK/TCL）.MethodsSixty-six patients with NK/TCL diagnosed from 2002 June to 2016 April in Beijing Tongren Hospital with intact CT and/or MRI imaging results were enrolled in this study. All the patients had tailed clinical information and follow-up. The imaging and clinicopathological features were analyzed retrospectively and their prognostic value on overall survival was analyzed.ResultsThere were 49 males and 17 females with median age of 42 years. The median follow-up time was 18 months. The cases showed surrounding invasions including 10 cases （15.2%） in soft palate, 5 cases （7.6%） in hard palate, 2 cases （3.0%） in tonsil, 8 cases （12.1%） in upper lip, 13 cases （19.7%） in maxillofacial soft tissue, 9 cases （13.6%） in eyelid, 10 cases （15.2%） in orbital, 3 cases （4.5%） in maxilla, 6 cases （9.1%） in pterygopalatine fossa, 6 cases （9.1%） in infratemporal fossa, 3 cases （4.5%） in skull base, 3 cases （4.5%） in eyeball and 2 cases （3.0%） in brain tissue. Kaplan-Meier survival analysis found that the 2-year overall survival rates of the patients with the involvement of hard palate, upper lip, maxillofacial soft tissue, eyelid, orbital, maxillary, eyeball and brain organizer were lower than those of the patients without the involvement of these sites （χ 2 values were 4.470, 4.041, 4.456, 13.933, 8.986, 4.000, 44.121, 6.527, 16.822, respectively, all P 〈 0.05）. Further multivariate Cox regression analysis showed that maxilla and brain involvement were independent adverse factors （RR=34.717, 95% CI 3.404-354.035, P = 0.003; RR = 37.545, 95% CI 3.188-442.187, P = 0.004）.ConclusionsMRI and CT examinations are of great value in diagnosis and prognostic assessment of NK/TCL. Clinicians can make correct and timely diagnosis by comprehensive clinical, radiological and pathological features and can make a detailed clinical assessment to give patients appropriate treatment, thus improving the outcome of the NK/TCL patients.