早期结外鼻型NK/T细胞淋巴瘤疗后远处淋巴结转移的临床特征  

Clinical features of distant lymph node metastasis 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] 王维虎[1] 金晶[1] 王淑莲[1] 刘跃平[1] 宋永文[1] 房辉[1] 任骅[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放疗科,100021

出　　处：《中华放射肿瘤学杂志》2014年第3期181-186,共6页Chinese Journal of Radiation Oncology

基　　金：北京市自然科学基金资助项目（7132184）

摘　　要：目的 分析ⅠE～ⅡE期原发上呼吸消化道NK/T细胞淋巴瘤（UADT-NKTCL）经治疗后远处淋巴结转移率及危险因素.方法 1979-2012年共收治468例Ⅰ E～ⅡE期UADT-NKTCL患者,其中170例接受单纯放疗、19例单纯化疗、278例综合治疗、1例抗炎治疗.采用Kaplan-Meier法计算远处淋巴结转移率.结果 中位随访35个月,32例出现远处淋巴结转移,绝对转移率为6.8％（32/468）,占总失败病例数的19.8％ （32/162）,2年远处淋巴结累积转移率为6.4％.71.9％（23/32）合并远处器官转移.最常见转移部位是腹腔淋巴结.单因素分析显示肿瘤原发于鼻腔外上呼吸消化道、ⅡE期、首程治疗疗效未达CR者是远处淋巴结转移的高危因素.多因素分析显示ⅡE期和首程治疗疗效未达CR是远期复发的独立危险因素,危险度分别为2.82（1.37 ～5.82,P=0.005）和3.01（1.16～7.78,P=0.023）.ⅡE期综合治疗组的远处淋巴结转移率显著低于单纯放疗组、单纯化疗组,2年远处淋巴结累积转移率分别为12.5％、35.1％、50.0％（P=0.011）.结论 早期UADTNKTCL治疗后远处淋巴结转移率较低,但对于ⅡE期和首程疗效未达CR者转移率仍较高.ⅡE期患者建议采用综合治疗以降低远处淋巴结转移率.Objective To analyze the incidence and risk factors for distant lymph node metastasis in stage Ⅰ E and Ⅱ E upper aerodigestive tract natural killer （NK）/T-cell lymphoma （UADT-NKTCL） after treatment.Methods From December 1979 to December 2012,468 patients with stage Ⅰ E and Ⅱ E UADTNKTCL were treated; 170 patients were treated with radiotherapy alone,19 patients with chemotherapy alone,278 patients with radiotherapy and chemotherapy,and one patient with anti-inflammation therapy.The incidence of distant lymph node metastasis was calculated by the Kaplan-Meier method.Results The median follow-up was 35 months.Thirty-two patients had distant lymph node metastasis,accounting for 6.8% of all patients and 19.8% of 162 patients who had disease progression or recurrence; the 2-year incidence of distant lymph node metastasis was 6.4%.Twenty-three （71.9%） of the 32 patients had distant organ metastasis.Mesenteric lymph nodes were most affected in distant lymph node metastasis.The univariate analysis showed that extranasal UADT-NKTCL,stage Ⅱ E,and not achieving a complete response （non-CR） after the first course of treatment were high-risk factors for distant lymph node metastasis.The multivariate analysis showed that stage ⅡE and non-CR after the first course of treatment were identified as independent risk factors for long-term recurrence,with hazard ratios of 2.82 （1.37-5.82,P =0.005） and 3.01 （1.16-7.78,P =0.023）.For patients with stage Ⅱ E disease,those receiving combined-modality therapy had a significantly lower incidence of distant lymph node metastasis than those receiving radiotherapy alone and chemotherapy alone （2-year incidence of distant lymph node metastasis：12.5% vs 35.1% and 50.0%,P =0.011）.Conclusions The incidence of distant lymph node metastasis is low in patients with stage Ⅰ E and Ⅱ E UADT-NKTCL after treatment.However,the patients with stage Ⅱ E disease or nonCR after the first course of treatment still have a high risk of distant lymph node metastasis

关 键 词：NK T细胞淋巴瘤 放射疗法 综合治疗 远处淋巴结转移 因素分析 

分 类 号：R733.1[医药卫生—肿瘤]