非上呼吸消化道结外NK/T细胞淋巴瘤的不良预后因素分析

Analysis of adverse prognostic factors of non-upper aerodigestive tract extranodal NK/T-cell lymphoma

目的:分析非上呼吸消化道来源的结外NK/T细胞淋巴瘤(non-upper aerodigestive tract extranodal NK/T-cell lymphoma,NUAT-ENKTCL)的不良预后因素。方法:回顾性分析郑州大学第一附属医院2011年1月至2015年12月收治的20例NUAT-NKTCL患者临床资料,采用Kaplan-Meier法进行生存分析,应用Log-Rank法检验对EBER表达、年龄、性别、乳酸脱氢酶(lactic dehydrogenase,LDH)水平和治疗前外周血EBV-DNA拷贝数等进行单因素分析。结果:20例患者中,男女比为13∶7。中位年龄为39(12～66)岁,其中≥60岁3例(15%),<60岁17例(85%)。Ann Arbor分期:Ⅰ、Ⅱ期8例(40%),Ⅲ、Ⅳ期12例(60%)。LDH水平升高12例(60%)。治疗前外周血EBV-DNA拷贝数增加11例(55%)。病变组织中EBER(+)13例(65%)。患者截至随访时间死亡4例,生存16例,中位总生存期(median overall survival,mOS)为15.4个月,中位无进展生存期(median progression free survival,mPFS)为8个月。完全缓解(complete response,CR)11例(55%),部分缓解(partial response,PR)5例(25%),客观缓解率(objective response rate,ORR)为80%。单因素分析显示年龄与预后呈显著相关性。结论:EBER的表达并不影响NUAT-ENKTCL患者的预后,年龄≥60岁患者预后较差。

Objective:To investigate the prognostic factors of non-upper aerodigestive tract extranodal NK/T-cell lymphoma(NUATNKTCL).Methods:Samples from twenty patients with NUAT-NKTCL,who were treated in The First Affiliated Hospital of Zhengzhou University between January 2011 and December 2015,were collected.The overall survival(OS)and progression-free survival(PFS)time of these patients were estimated by the Kaplan-Meier method.Through the log-rank test,the survival curves were compared among EBER expression,age,lactate dehydrogenase(LDH)level,EBV-DNA copies,and gender.Results:The male-female ratio of patients was 13:7.The median age was 39 years(range 12-66),with 3 patients above 60 years(15%)and the others below 60 years(85%).Forty percent of the patients were Ann-Arbor stageⅠ/Ⅱand 60%of them were Ann-Arbor stageⅢ/Ⅳ.Twelve patients(60%)had a high level of LDH.Eleven patients had a high level of EBV-DNA copies in peripheral blood(55%)before treatment.Thirteen patients were EBER positive.Among the 20 patients,4 patients died and 16 survived.The median OS was 15.4 months,and the median PFS was 8 months.Eleven patients received CR,5 achieved PR while the ORR was 80%.The Log-rank test showed a significant association between age and prognosis(P=0.001).Conclusions:There was no correlation between EBER expression and prognosis of NUAT-NKTCL.Patients over 60 years of age had a poor prognosis.