早期鼻腔NK/T细胞淋巴瘤治疗方法和预后分析  

Treatment modality and prognostic analysis of early stage nasal NK/T cell lymphomas

作　　者：聂大红[1] 谢方云[2] 李济时[2] 刘宜敏[3] 伍勇[4] 

机构地区：[1]中山大学附属第一医院影像科,广州510080 [2]中山大学肿瘤防治中心放疗科 [3]中山大学附属第二医院放疗科 [4]广州医学院附属广州市第一人民医院肿瘤科

出　　处：《中华放射肿瘤学杂志》2010年第4期315-319,共5页Chinese Journal of Radiation Oncology

摘　　要：目的 探讨不同治疗方法对早期鼻腔NK/T细胞淋巴瘤预后的影响.方法 回顾分析15年问85例ⅠE、ⅡE期鼻腔NK/T淋巴瘤放疗及CHOP为主化疗的疗效.单纯化疗（单化组）20例,放疗后±化疗（放化组）17例（单纯放疗11例）,化疗后放疗（化放组）48例.生存率计算采用Kaplan-Meier法,并Logrank法检验,Cox回归模型进行多因素分析.结果 全组5年生存率为40%,单化纽、放化组和化放组的分别为13%、54%和47%,放化纽和化放组均优于单化组（P=0.030和0.049）.ⅠE局限组与超腔组的5年生存率分别为57%与28%（χ2=8.87,P=0.003）,ⅡE期的为23%,与ⅠE超腔组相似（χ2=0.19,P=0.664）.近期疗效达到完全缓解与未完全缓解的5年生存率分别为58%与12%（χ2=30.68,P=0.000）.放疗剂量≤50 Gy与〉50 Gy的完全缓解率分别为56%和86%（χ2=6.11,P=0.013）,5年无复发生存率分别为89%与84%（χ2=0.36,P=0.551）.首程化疗的68例中≤2、3～4、≥5个疗程者分别为18、20、30例,完全缓解率分别为0%、20%、33%（χ2=7.65,P=0.022）.首程先化疗且≥3个疗程的50例和先放疗≥40 Gy的17例的完全缓解率分别为28%和88%（χ2=18.75,P=0.000）.结节型和溃疡型的完全缓解率放疗均优于化疗（100%：38%,2X=7.92,P=0.005和100%：11%,χ2=14.40,P=0.000）.多因素分析显示临床分期和近期疗效是影响预后的独立因素.结论 早期鼻腔NK/T细胞淋巴瘤首程应选择50 Gy放疗为宜.对于ⅠE期超腔与ⅡE期应酌情联合化疗,但CHOP方案效果欠佳.Objective To investigate the prognosis of patients with nasal NK/T cell lymphoma receiving different treatment modalities. Methods From 1990 to 2004, 85 patients with stage ⅠE and ⅡE primary nasal NK/T cell lymphomas were retrospectively studied. Twenty patients received chemotherapy of CHOP regimen alone, 11 patients received radiotherapy only, 6 patients received radiotherapy followed by more than 2 cycles of chemotherapy, and 48 patients received more than 2 cycles of chemotherapy followed by radiotherapy. Survival analysis was performed by the Kaplan-Meier method, the difference between groups was evaluated by the Log-rank test, and the Cox regression model was used for multivariate analysis. Results The 5-year overall survival rate （OS） was 40%. The 5-year OS was 57% and 28% for limited stage ⅠE and extended stage ⅠE（X2 =8. 87, P =0. 003）, and 23% for stage ⅡE, which was similar to extended stage ⅠE （X2 =0. 19, P-0. 664）. The 5-year OS was 13%, 54% and 47% for chemotherapy alone, radiotherapy followed with or without chemotherapy, and chemotherapy followed by radiotherapy, respectively. The last two groups had better OS than chemotherapy alone （P = 0. 030 and 0.049）. The 5-year OS was 58% and 12% for patients achieving complete response （CR） and uncomplete response （X2 = 30.68, P = 0. 000）.The CR rate was 56% and 86% for radiotherapy of ≤50 Gy and 〉50 Gy （X2 =6.11, P=0. 013）. The corresponding 5-year relapse-free survival rate was 89% and 84% （X2 =0.36, P=0.551）. Of 68 patients receiving initial chemotherapy, the CR rate of those who received ≤2, 3-4 and ≥5 cycles was 0, 20%and 3 3 % , respectively （X2 = 7.65 , P = 0. 022） . For 5 0 patients who received ≥ 3 cycles of initial chemotherapy and 17 patients who received initial radiotherapy of ≥40 Gy, the CR rate was 28% and 88%（χ2= 18. 75, P= 0. 000）. In patients with pathological nodular and ulcer type, the CR rates with radiotherapy were higher than with chemotherapy （100%： 38%, χ2 = 7.92,

关 键 词：淋巴瘤 NK/T细胞/放射疗法 淋巴瘤 NK/T细胞/化学疗法 预后 

分 类 号：R686[医药卫生—骨科学]