早期结外NK/T细胞淋巴瘤鼻型同步与非同步放化疗疗效分析

Analysis of treatment results of concurrent and asynchronous radiochemotherapy for early extranodal NK/T cell lymphoma

目的比较早期结外NK/T细胞淋巴瘤鼻型(NKTCL)同步与非同步放化疗疗效。方法收集2007—2020年贵州医科大学附属肿瘤医院收治的278例早期NK/T细胞淋巴瘤综合治疗患者,按Nomogram改进版风险指数(NRI)预后模型,根据有无任何预后不良因素[年龄>60岁、血清乳酸脱氢酶(LDH)增高、美国东部肿瘤协作组(ECOG)评分≥2分、原发肿瘤侵犯(PTI)、Ann Arbor分期Ⅱ期]分为预后良好组49例,以及含有任何一项预后不良因素的预后不良组229例。其中145例采用同步放化疗,133例采用非同步放化疗。结果全组5年总生存(OS)率为71.0%,无进展生存(PFS)率为67.6%。预后良好组和预后不良组5年OS率分别为95.6%和65.4%(P<0.001)。预后不良组中NRI=1分中低危组、NRI=2分中高危组、NRI≥3分高危组患者各组的5年OS率分别为72.1%、61.1%、47.7%(P=0.007)。同步放化疗组与非同步放化疗组疗效无显著差异,5年OS率分别为70.6%、69.8%(P=0.783)、5年PFS率分别为67.6%、65.2%(P=0.631)。进一步分层分析显示,NRI=1分中低危组患者同步放化疗组与非同步放化疗组5年OS率分别为73.1%、76.5%(P=0.576),NRI=2分中高危组患者分别为62.6%、69.3%(P=0.427),NRI≥3分高危组患者分别为58.1%、42.3%(P=0.954),均无明显差异。结论综合治疗能显著改善预后不良组早期NKTCL的预后,在放化疗的顺序上同步放化疗和非同步放化疗5年OS率、5年PFS率无显著差异。对于预后不良早期NKTCL可以采用耐受性更好的序贯治疗。

Objective To compare the efficacy of concurrent and asynchronous radiochemotheray for early extranodal nasal natural killer/T-cell lymphoma(NKTCL).Methods From 2007 to 2020,278 patients with early NKTCL treated with comprehensive treatment in the Affiliated Tumor Hospital of Guizhou Medical University were recruited.According to the adjusted Nomogram-revised risk index(NRI)prognostic model,there were 49 cases in the good prognostic group without adverse prognostic factors(age>60 years old,increased serum lactate dehydrogenase(LDH),ECOG score≥2,primary tumor invasion(PTI),Ann Arbor stageⅡ,and 229 cases in the poor prognostic group with any adverse prognostic factors.145 of these cases were treated with concurrent radiochemotherapy,and 133 of them were treated with asynchronous radiochemotherapy.Results The 5-year overall survival(OS)rate of the whole group was 71.0%,and the progression-free survival(PFS)rate was 67.6%.The 5-year OS rate in the good prognostic group was 95.6%,and 65.4%in the poor prognostic group(P<0.001).In the poor prognostic group,the 5-year OS rates of patients with NRI=1(low-and moderate-risk group),NRI=2(moderate-and high-risk group),NRI≥3(high-risk group)were 72.1%,61.1%and 47.7%,respectively(P=0.007).There was no significant difference in curative effect between the concurrent and asynchronous radiochemotherapy groups.The 5-year OS rates were 70.6%and 69.8%(P=0.783),and the 5-year PFS rates were 67.6%and 65.2%(P=0.631).Further stratified analysis showed that the 5-year OS rates of patients with NRI=1 receiving concurrent and asynchronous radiochemotherapy were 73.1%and 76.5%(P=0.576),62.6%and 69.3%(P=0.427)for those with NRI=2,and 58.1%and 42.3%for those with NRI≥3(P=0.954).Conclusions Comprehensive treatment can significantly improve the prognosis of early NKTCL in the poor prognostic group.In the sequence of radiotherapy and chemotherapy,there is no significant difference in 5-year OS and PFS rates between concurrent and asynchronous radiochemotherapy.Sequential treatment with better tolerance can be adopted for early NKTCL with poor prognosis.