Primary site and regional lymph nodeinvolvement are independent prognosticfactors for early？stage extranodal nasal？typenatural killer/T cell lymphoma

Background:Nasal-type extranodal natural killer/T-cell lymphoma(ENKTCL) originates primarily in the nasal cavity or extra-nasal sites within the upper aerodigestive tract.However,it is unclear whether the primary site can serve as an independent prognostic factor or whether the varying clinical outcomes observed with different primary sites can be attributed merely to their propensities of regional lymph node involvement.The aim of this study was to investigate the prognostic implications of the primary site and regional lymph node involvement in patients with early-stage nasal-type ENKTCL.Methods:To develop a nomogram,we reviewed the clinical data of 215 consecutively diagnosed patients with early-stage nasal-type ENKTCL who were treated in Sun Yat-sen University Cancer Center with chemotherapy and radiotherapy between 2000 and 2011.The predictive accuracy and discriminative ability of the nomogram were determined using a concordance index(C-index) and calibration curve.Results:The 5-year overall survival(OS) and progression-free survival(PFS) rates of patients with nasal ENKTCL were higher than those of patients with extra-nasal ENKTCL(OS:68.2%vs.46.0%,P = 0.030;PFS:53.4%vs.26.6%,P = 0.010).The 5-year OS and PFS rates of patients with Ann Arbor stage IE ENKTCL were higher than those of patients with Ann Arbor stage HE ENKTCL(OS:66.3%vs.59.2%,P = 0.003;PFS:51.4%vs.40.3%,P = 0.009).Multivariate analysis showed that age >60 years,ECOG performance status score >2,elevated lactate dehydrogenase(LDH) level,extranasal primary site,and regional lymph node involvement were significantly associated with lower 5-year OS rate;age >60 years,elevated LDH level,extra-nasal primary site,and regional lymph node involvement were significantly associated with lower 5-year PFS rate.The nomogram included the primary site and regional lymph node involvement based on multivariate analysis.The calibration curve showed good agreement between the predicted and actual 5-year OS and PFS rates,and the C-indexes of the nomogram for the OS and PFS rates were 0.697 and 0.634,respectively.Conclusions:The primary site and regional lymph node involvement are independent prognostic factors for earlystage ENKTCL treated with chemotherapy followed by definitive radiotherapy.

同步放化疗联合每周多西他赛与顺铂治疗局部晚期鼻咽癌的比较：一项倾向性评分匹配分析

背景与目的基于多西他赛的同步放化疗(concurrent chemoradiotherapy,CCRT)治疗头颈部肿瘤疗效显著且毒性可控。CCRT联合顺铂和/或5-氟尿嘧啶治疗局部晚期和转移性/复发性鼻咽癌(nasopharyngeal carcinoma,NPC)疗效确切。但是,CCRT联合多西他赛治疗局部晚期NPC尚无明确报道。本研究旨在比较CCRT联合每周多西他赛与3周1次顺铂治疗局部晚期NPC的疗效及毒性。方法评估2010年1月至2014年12月新确诊为局部晚期NPC患者的临床资料,患者均接受了CCRT联合每周1次多西他赛(15mg/m^2)或3周1次顺铂(80–100 mg/m2)的治疗。为平衡基线特征,进行了1∶1的特征评分匹配。比较两组间的不良事件和生存期。结果本研究共纳入962例患者,对其中448例患者进行了匹配并认定为匹配队列。整体队列的平均随访持续时间为48个月。在整体队列[风险比(hazard ratio,HR)=0.37,95%置信区间(confidence interval,CI):0.19–0.72,P=0.030]和匹配队列(HR=0.33,95%CI:0.14–0.79,P=0.023)两组中,接受多西他赛治疗患者的3年淋巴结无复发生存率均显著提高。然而,在2个队列中,总生存期、无局部复发生存期,无远端转移生存期均无显著差异。多西他赛组中患者的3级放射性皮炎(6.7%vs.1.8%,P=0.001)、黏膜炎(74.5%vs.37.9%,P<0.001)的发生率显著增高,而顺铂组患者多发任意级别的肾损伤(1.8%vs.15.1%,P<0.001)、呕吐(18.8%vs.88.3%,P<0.001)和ALT升高(19.2%vs.31.3%,P=0.027)及白细胞减少(2.2%vs.11.6%,P<0.001)。结论CCRT联合每周低剂量多西他赛对局部NPC患者是一种有效且可耐受的治疗方案。尤其是针对治疗前EBV DNA水平较低的患者,该方案可主要通过提高控制局部淋巴结转移进而使患者获得良好的生存获益。