体质指数与Ⅲ～Ⅳ期初治NK/T细胞淋巴瘤预后的相关性研究

Association between body mass index and prognosis of primary NK/T-cell lymphoma in Ⅲ-Ⅳ stage

目的:探讨体质指数(BMI)对晚期结外NK/T细胞淋巴瘤(ENKTL)疗效及预后的影响。方法:回顾性分析81例经免疫组织化学证实的Ⅲ~Ⅳ期ENKTL患者的临床资料,以BMI=20 kg/m^2为临界值,BMI≥20 kg/m^2的59例患者纳入高BMI组,BMI<20 kg/m^2的22例患者纳入低BMI组。使用χ^2检验分析BMI与ENKTL患者疗效的相关性;采用Kaplan-Meier法绘制生存曲线,并采用COX比例风险模型进行多因素分析,研究影响ENKTL预后的因素。结果:低BMI组与高BMI组在ECOG评分、乳酸脱氢酶水平、EBV-DNA、性别、年龄等临床因素方面比较差异无统计学意义;2组完全缓解率及总有效率比较差异有统计学意义(χ^2=4.855,P=0.028;χ^2=10.903,P=0.001),无进展生存及总生存率比较差异无统计学意义(Log-rank P=0.079;Log-rank P=0.150)。单因素分析显示,年龄、ECOG评分、β2微球蛋白、PINK评分是Ⅲ~Ⅳ期ENKTL患者的不良预后因素;多因素分析显示,年龄、ECOG评分、PINK评分、BMI是影响Ⅲ~Ⅳ期ENKTL患者预后的独立危险因素。结论:BMI能影响Ⅲ~Ⅳ期ENKTL患者的近期疗效,但未能明显改善远期生存率,高BMI是影响预后的保护性因素。

Objective:To explore the effect of body mass index(BMI)on the efficacy and prognosis in patients with advanced extranodal natural killer/T-cell lymphoma(ENKTL).Method:The clinical data of 81 patients with stageⅢ-ⅣENKTL confirmed by immunohistochemistry were retrospectively analyzed.Fifty-nine patients with BMI≥20 kg/m^2 were enrolled in the high BMI group and 22 patients with BMI<20 kg/m^2 were enrolled in the low BMI group.Chi-square test was used to analyze the correlation between BMI and the efficacy of ENKTL patients,Kaplan-Meier method was used to draw survival curve and COX proportional risk model was used to analyze the factors affecting the prognosis of ENKTL.Result:There was no significant difference in ECOG score,lactate dehydrogenase level,EBV-DNA,gender,age and other clinical factors between low BMI group and high BMI group.There were significant differences in complete remission rate and total effective rate between the two groups(χ^2=4.855,P=0.028;χ^2=10.903,P=0.001),and there was no significant difference in progression-free survival and total survival rate between the two groups(Log-rank P=0.079;Log-rank P=0.150).Univariate analysis showed that age,ECOG score,β2-microglobulin and PINK score were adverse prognostic factors for patients with stageⅢ-ⅣENKTL.Multivariate analysis showed that age,ECOG score,PINK score and BMI were independent risk factors affecting the prognosis of patients with stageⅢ-ⅣENKTL.Conclusion:BMI can affect the short-term efficacy of patients with stageⅢ-ⅣENKTL,but it cannot significantly improve the long-term survival rate.High BMI is a protective factor affecting prognosis of patients with stageⅢ-ⅣENKTL.