早期结外鼻型NK／T细胞淋巴瘤疗后远期复发因素分析  

Analysis of risk factors for late relapse in early-stage extranodal nasal-type NK/T-cell lymphoma after treatment

作　　者：陈波[1] 李晔雄[1] 刘清峰[1] 金晶[1] 王维虎[1] 王淑莲[1] 刘跃平[1] 宋永文[1] 房辉[1] 任骅[1] 赵婷[1] 吴润叶[1] 刘新帆[1] 余子豪[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院肿瘤研究所放疗科,100021

出　　处：《中华放射肿瘤学杂志》2013年第3期175-179,共5页Chinese Journal of Radiation Oncology

基　　金：卫生部临床重点学科项目（136）

摘　　要：目的分析IE～ⅡE期上呼吸消化道NK／T细胞淋巴瘤（UADT-NKTCL）经治疗后无瘤生存超过5年患者的远期复发率及危险因素。方法1983--2007年共114例IE～ⅡE期UADT-NKTCL患者疗后5年内无瘤生存，其中32例单纯放疗、80例化放疗、2例单纯化疗。采用Kaplan．Meier方法计算复发率并Logrank检验及危险因素的单因素分析，Cox模型进行多因素分析。结果随访率100％，随访时间满10年者79例。全组5年后复发12例（10．5％），复发中位时间8．2年（5．1～23．1年）。复发者中50％出现局部区域复发而无远处器官或淋巴结受累。全组10年肿瘤特异生存率和累积远期复发率分别为92．2％和8．4％。单因素分析显示初诊时有全身症状、ECOG评分≥2分、单纯化疗、初治时放疗剂量〈50Gy是远期复发因素（X2=4．00～11．14，P=0．004～0．045），多因素分析显示初诊存在全身症状是远期复发危险因素[HR=4．74（95％C1=1．33～16．94），X2=5．73，P=0．017]。结论早期UADT-NKTCL疗后5年内无瘤生存者仍有部分会出现复发。初诊时全身症状是UADT-NKTCL远期复发的独立危险因素。Objective To analyse the late relapse rate of stage IE and IIE upper aerodigestive tract natural killer/T-cell lymphoma （UADT-NKTCL） in patients with a disease-free survival （DFS） of at least 5 years after treatment and the risk factors for late relapse. Methods Between January 1983 and October 2007, 114 patients with stage IE and IIE UADT-NKTCL received radiotherapy, chemoradiotherapy, or chemotherapy and had a DFS of at least 5 years after treatment. Of the 114 patients, 32 received radiotherapy alone, 80 received chemoradiotherapy, and 2 received chemotherapy alone. The Kaplan-Meier method was used to calculate the relapse rate, and the logrank test was used for survival difference analysis and univariate analysis of risk factors;the Cox regression model was used for multivariate analysis. Results The follow-up rate was 100%. The number of patients followed-up were 79 at 10 years time. Twelve patients had late relapse （ 10. 5% ）. 50% （ 6/12 ） patients with late relapse developed first locoregional relapse without systemic failure. The 10-year cancer-specific survival and cumulative probabilities of late relapse for entire patients were 92. 2% and 8.4% , respectively. In univariate analysis, B symptoms, ECOG ≥2, chemotherapy alone and the close of RT 〈 50 Gy were risk factors to incidence of late relapse （ X2 = 4. 00 -11.14, P = 0. 004 -0. 045 ）. In multivariate analysis, B symptom was identified as independent correlative factor to incidence of late relapse （ HR = 4. 74 （ 95% CI = 1.33 - 16. 93 ） , X2 = 5.73, P = 0. 017）. Conclusions Relapse occurs in a small proportion of patients with early-stage UADT-NKTCL who have a DFS of at least 5 years. Systemic symptoms at initial diagnosis is the independent risk factor for late relapse in UADT-NKTCL.

关 键 词：淋巴瘤 鼻型 复发 因素分析 

分 类 号：R733.1[医药卫生—肿瘤]