EB病毒感染与鼻型结外NK/T细胞淋巴瘤患者预后的关系

Relationship between EB virus infection and prognosis of patients with extranodal nasal-type NK/T cell lymphoma

目的探究EB病毒(EBV)感染与鼻型结外自然杀伤(NK)/T细胞淋巴瘤患者预后的关系。方法选取2013年8月-2016年10月于中山大学第五附属医院治疗的鼻型结外NK/T细胞淋巴瘤患者120例,采用实时荧光定量聚合酶链式反应(qRT-PCR)检测患者外周静脉血EBV-DNA拷贝数,划分为EBV阳性组和EBV阴性组,其中EBV阳性组根据患者是否接受抗EBV治疗,分为抗EBV治疗组和未抗EBV治疗组。比较两组患者临床病理特征、治疗效果及预后情况,并分析患者预后影响因素。结果与EBV阴性组比较,EBV阳性组患者安阿伯(Ann Arbor)分期更晚,自然杀伤细胞淋巴瘤预后指数(PINK)中、高危比例更大,且乳酸脱氢酶(LDH)≥240 U/L比例更大(P<0.05);EBV阳性组客观缓解率为44.68%,低于EBV阴性组(P<0.05);抗EBV治疗组客观缓解率为83.33%,高于未抗EBV治疗组(P<0.05);随访至2019年10月31日,120例患者中存活77例,病死43例(35.83%);EBV阳性组2年、3年总生存期(OS)率和无进展生存期(PFS)率均低于EBV阴性组(P<0.05);治疗前EBV-DNA阳性是患者3年PFS和OS的独立预后危险因素(P<0.05)。结论鼻型结外NK/T细胞淋巴瘤患者EBV感染可降低患者临床疗效,与其临床病理特征和预后密切相关。

OBJECTIVE To explore the relationship between EB virus(EBV)infection and prognosis of patients with extranodal nasal-type natural killer(NK)/T cell lymphoma.METHODS A total of 120 patients with extranodal nasal-type NK/T cell lymphoma who were treated in the Fifth Affiliated Hospital of Zhongshan University from Aug 2013 to Oct 2016 were enrolled in the study.The copy number of EBV-DNA in peripheral venous blood was detected by real time fluorescent quantitative reverse transcription-polymerase chain reaction(qRT-PCR).The enrolled patients were divided into the EBV-positive group and the EBV-negative group.According to presence or absence of anti-EBV treatment,the patients of the EBV-positive group were divided into the anti-EBV treatment group and the non-anti-EBV treatment group.The clinicopathological features,curative effect and prognosis were compared between the two groups of the patients.The influencing factors for the prognosis were observed.RESULTS Ann Arbor staging was later in the EBV-positive group than in the EBV-negative group;the proportion of middle to high risk prognostic index NK(PINK)was greater,and the proportion of lactic dehydrogenase(LDH)with no less than 240 U/L was significantly greater(P<0.05).The objective response rate of the EBV-positive group was 44.68%,significantly lower than that of the EBV-negative group(P<0.05).The objective response rate of the anti-EBV treatment group was 83.33%,significantly higher than that of the non-anti-EBV treatment group(P<0.05).The follow-up that lasted till Oct 31,2019 showed that 77 of 120 patients survived,and 43(35.83%)died due to illness.The 2-year and 3-year overall survival(OS)rates and progression free survival(PFS)rates were significantly lower in the EBV-positive group than in the EBV-negative group(P<0.05).The EBV tested positive before the treatment was an independent prognostic risk factor for 3-year PFS and OS(P<0.05).CONCLUSION The EBV infection may reduce the clinical curative effect of the patients with extranodal nasal-type NK/T cell lymphoma,which is closely related to their clinicopathological features and prognosis.