摘要
目的探讨结外NK/T细胞淋巴瘤鼻型(ENKTL)患者治疗前B症状与血浆EBV-DNA拷贝数和血清细胞因子水平的相关关系,并分析其机制和预后价值。方法回顾性分析资料齐全的173例患者,其中男性116例,女性57例,中位年龄43岁(4~71岁)。Ann Arbor分期Ⅰ-Ⅱ期126例,Ⅲ-Ⅳ期47例。肿瘤原发部位包括鼻腔(100例)、非鼻腔上呼吸消化道(34例)和上呼吸消化道以外(39例)。治疗前有和无B症状者分别为91例和82例。按照血浆EBV-DNA拷贝数的高低分为阴性组36例、低载量(<104 copies/ml)组73例和高载量(≥104 copies/ml)组64例。检测的血清细胞因子包括IFN-γ、IL-2、IL-4、IL-6、IL-10和TNF-α。相关性分析采用Cochran-Armitage趋势检验和Spearman相关性分析,采用Cox回归风险模型进行单因素分析评估预后影响因素并用Kaplan-Meier法绘制生存曲线。结果B症状及发热的发生与血浆EBV-DNA拷贝水平的增加呈显著一致的趋势,发生B症状的患者其血清IFN-γ、IL-6和IL-10的水平均高于无B症状组(P均<0.001)。血清IFN-γ、IL-6和IL-10水平也均与血浆EBV-DNA拷贝数呈正相关。B症状的发生与ENKTL患者的高危临床特征相关,包括晚期、原发肿瘤局部侵犯、区域淋巴结累及和治疗前LDH升高。单因素生存分析显示,Ann Arbor分期、B症状、血浆EBV-DNA及上述血清细胞因子均为OS和PFS的影响因素(P均<0.05)。然而,多因素分析并未显示B症状对生存的独立预后价值。结论ENKTL患者B症状的发生与EBV-DNA拷贝水平和细胞因子的增高有关,这些指标也是影响ENKTL患者预后的重要因素。
Objective To investigate the association of plasma EBV-DNA copy number,serum cytokines and B symptoms in patients with extranodal natural killer/T-cell lymphoma,nasal type(ENKTL),unravel the mechanism and assess the prognostic value of clinical indicators.Methods Clinical data of 173 newly-diagnosed ENKTL patients(116 male,57 female;median age:43,4 to 71 years)were retrospectively analyzed.According to Ann Arbor stage,126 cases were classified as stage I-II and 47 cases of stageⅢ-IV.The primary sites of tumors included nasal cavity(n=100),extranasal upper aerodigestive tract(extranasal UADT,n=34),and extra-upper aerodigestive tract(extra-UADT,n=39).Prior to treatment,91 patients had B symptoms and 82 cases of without B symptoms.According to plasma EBV-DNA copy levels,all patients were divided into the negative group(n=36),low load group(<104 copies/ml,n=73)and high load group(≥104 copies/ml,n=64).Serum cytokines including IFN-γ,IL-2,IL-4,IL-6,IL-10 and TNF-αwere detected.Correlation analysis was performed by Cochran-Armitage trend test and Spearman correlation analysis.Survival analysis was conducted using univariate and multivariate Cox regression hazard analysis and survival curves were derived from Kaplan-Meier survival analysis.Results The incidence of B symptoms and fever showed a significant upward trend with the increasing plasma EBV-DNA copy levels.In addition,serum levels of IFN-γ,IL-6 and IL-10 cytokines were higher in patients with B symptoms than those without B symptoms(all P<0.05).Serum IFN-γ,IL-6,and IL-10 levels were also positively correlated with plasma EBV-DNA copy number.The occurrence of B symptoms was associated with high-risk clinical features including advanced stage,primary tumor invasion,regional lymph node involvement,and elevated pre-treatment LDH.Survival analysis showed that stage,B symptoms,plasma EBV-DNA,and the above serum cytokines affected the prognosis of overall survival(OS)and progression-free survival(PFS)(all P<0.05).However,multivariate analysis showed that the occurrence of B symptoms was not an independent prognostic factor of ENKTL patients.Conclusion This exploratory study suggests that the incidence of B symptoms is associated with increasing levels of EBV-DNA copies and cytokines,and these indicators are also important factors influencing the prognosis of ENKTL patients.
作者
张跃桐
张玉晶
王继金
邵晗
王汉渝
戴淑琴
黄慧强
Yuetong Zhang;Yujing Zhang;Jijin Wang;Han Shao;Hanyu Wang;Shuqin Dai;Huiqiang Huang(Department of Radiation Oncology,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in Southern China,Collaborative Innovation Center for Cancer Medicine,Guangzhou 510060,China;Department of Medicine Laboratory,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in Southern China,Collaborative Innovation Center for Cancer Medicine,Guangzhou 510060,China;Departments of Medical Oncology,Sun Yat-sen University cancer center,State Key Laboratory of Oncology in Southern China,Collaborative Innovation Center for Cancer Medicine,Guangzhou 510060,China)
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2022年第8期704-709,共6页
Chinese Journal of Radiation Oncology