结外鼻型NK/T细胞淋巴瘤患者淋巴细胞绝对计数的预后价值

Prognostic value of absolute lymphocyte count in patients with extranodal nasal NK/T cell lymphoma

目的探讨淋巴细胞绝对计数(ALC)与结外鼻型NK/T细胞淋巴瘤(ENKTL)预后之间的关系。方法回顾性分析2002年1月至2018年12月山西省肿瘤医院和山西省大同市第二人民医院收治的184例ENKTL患者资料。采用Contal-O'Quigley变点法计算ALC预测ENKTL预后最佳临界值,依此值将患者分为两组。采用Kaplan-Meier法对两组患者进行生存分析。采用Cox比例风险回归模型进行单因素及多因素生存分析。结果根据Contal-O'Quigley变点法确定ALC预测ENKTL预后的最佳临界值为1.5×10^(9)/L,按此值将患者分为ALC>1.5×10^(9)/L组(98例)和ALC≤1.5×10^(9)/L组(86例)。与ALC≤1.5×10^(9)/L组比较,ALC>1.5×10^(9)/L组患者美国东部肿瘤协作组(ECOG)评分≥2分、血清乳酸脱氢酶(LDH)>245 U/L、韩国预后指数(KPI)评分2~4分、国际预后指数(IPI)评分2~5分患者比例低,血红蛋白>120 g/L患者比例高(均P<0.05)。ALC>1.5×10^(9)/L组总生存(OS)和无进展生存(PFS)均优于ALC≤1.5×10^(9)/L组(3年OS率:65.7%比45.4%,5年OS率:61.0%比36.6%;3年PFS率:61.7%比41.0%,5年PFS率:51.9%比32.2%;均P<0.05)。多因素Cox回归分析显示,ECOG评分、血清LDH水平、ALC、是否放疗及是否应用含左旋门冬酰胺酶方案化疗是OS和PFS的独立影响因素(均P<0.05);其中对于OS,ALC>1.5×10^(9)/L与≤1.5×10^(9)/L相比的RR为0.634(95%CI 0.398~1.008,P=0.050),对于PFS,RR为0.625(95%CI 0.406~0.962,P=0.033)。结论高ALC的ENKTL患者预后较好,ALC可能是ENKTL的一种强有力预后因素。

Objective To investigate the relationship between absolute lymphocyte count(ALC)and prognosis of extranodal nasal NK/T cell lymphoma(ENKTL).Methods The data of 184 patients with ENKTL who were admitted to Shanxi Provincial Cancer Hospital and the Second People's Hospital of Datong in Shanxi Province from January 2002 to December 2018 were retrospectively analyzed.Contal-O'Quigley variable point method was used to calculate the optimal cut-off value of ALC for predicting the prognosis of ENKTL,and the patients were divided into two groups based on this value.Kaplan-Meier method was used to analyze the survival of the two groups of patients.Cox proportional hazard regression model was used for univariate and multivariate survival analyses.Results According to the Contal-O'Quigley variable point method,the best cut-off value of ALC for predicting ENKTL prognosis was 1.5×10^(9)/L.According to this value,patients were divided into ALC>1.5×10^(9)/L group(98 cases)and ALC≤1.5×10^(9)/L group(86 cases).Compared with the ALC≤1.5×10^(9)/L group,the proportions of patients with Eastern Cooperative Oncology Group(ECOG)score≥2 points,serum lactate dehydrogenase(LDH)>245 U/L,Korean prognostic index(KPI)score 2-4 points and international prognostic index(IPI)score 2-5 points were lower in the ALC>1.5×10^(9)/L group,but the proportion of patients with hemoglobin>120 g/L was higher(all P<0.05).The overall survival(OS)and progression-free survival(PFS)in the ALC>1.5×10^(9)/L group were better than those in the ALC≤1.5×10^(9)/L group(3-year OS rate:65.7%vs.45.4%,5-year OS rate:61.0%vs.36.6%;3-year PFS rate:61.7%vs.41.0%,5-year PFS rate:51.9%vs.32.2%;all P<0.05).Multivariate Cox regression analysis showed that ECOG score,serum LDH level,ALC,radiotherapy and L-asparaginase-containing chemotherapy were independent influencing factors of OS and PFS(all P<0.05),and for OS,when ALC>1.5×10^(9)/L compared with≤1.5×10^(9)/L,RR was 0.634(95%CI 0.398-1.008,P=0.050),and for PFS,RR was 0.625(95%CI 0.406-0.962,P=0.033).Conclusion Patients with high ALC have good prognosis,and therefore ALC may be a powerful prognostic factor of ENKTL.