结外鼻型NK/T细胞淋巴瘤临床特征分析  

Extranodal NK/T-cell lymphoma,nasal type:a clinical analysis

作　　者：陈芳[1] 申聪香[1] 王会刚[1] 李冠雪[1] 王晓琪[1] 文忠[1] 

机构地区：[1]南方医科大学附属珠江医院耳鼻咽喉头颈外科,广州510282

出　　处：《临床耳鼻咽喉头颈外科杂志》2017年第5期327-333,共7页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨结外鼻型NK/T细胞淋巴瘤的临床诊疗特征及其影响因素,为临床个体化治疗提供依据和经验。方法:回顾性分析2009-12-2016-07期间收治的25例结外鼻型NK/T细胞淋巴瘤患者的临床资料,包括临床表现、血清EBV-DNA检测、影像学检查、Ann-Arbor分期、病理、治疗方法及预后等。所有患者均由病理确诊并进行标准、规范及系统的治疗。采用Kaplan-Meier法和Log-rank检验进行单因素生存分析,Cox模型进行多因素分析并对影响预后的临床因素进行危险性评估。结果:25例患者中ⅠE+ⅡE期15例(60%),1年、3年总生存率(OS)分别为100%、100%;ⅢE+ⅣE期10例(40%),1年、3年OS分别为40.0%、26.7%,两者间OS差异有统计学意义(P=0.000)。采用单独放疗3例,1年、3年OS分别为100%、100%;单独化疗6例,1年、3年OS分别为53.6%、35.7%;放疗联合化疗综合治疗模式16例,1年、3年OS分别为84.6%、84.6%。3种治疗模式之间OS差异有统计学意义(P=0.027),且单独化疗者预后最差。进一步的多因素Cox回归模型结果显示,病程、B症状、EBV-DNA拷贝数阳性、治疗模式与该患者的预后转归关系密切(P=0.006、0.003、0.010、0.040)。结论:结外鼻型NK/T细胞淋巴瘤侵袭性强,总体预后较差。Ann-Arbor分期、治疗模式、病程、B组症状、EBV-DNA拷贝数阳性与结外鼻型NK/T细胞淋巴瘤的预后有密切关系。对早期局限于鼻腔的患者可单独放疗,疗效较好;对侵袭范围较大或晚期患者宜首选放疗加化疗为主的联合治疗模式。Objective：To explore the clinical diagnosis and treatment characteristics and clinical factors of extranodal NK/T-cell lymphoma,nasal type and provide the basis for clinical individual therapy and experience.Method：The 25 cases personal data of ENKTL received from December in 2009 to July in 2016 by our department including clinical manifestation,the serum EBV-DNA detection,imaging examination,Ann-Arbor staging,histological grade,treatment,and prognosis,etc.were retrospectively analyzed.All of the patients were pathological diagnosis and received standard,specification and system treatment.Single factor survival analysis was performed by Kaplan-Meier method and Log-rank test,and multivariate analysis was carried out using Coxproportional hazard model in the risk assessment about the factors affecting the prognosis of clinical.Result：Of the 25 patients,15cases（60%）were in stageⅠE-ⅡE,which 1year and 3years（overall survival）OS were 100%,100% respectively and 10cases（40%）were in stageⅢE-ⅣE,which 1year and 3years OS were respectively 40.0%,26.7%.It had significant statistical difference（P=0.000）.Radiotherapy alone in 3cases which 1year and 3years OS were respectively 100%,100%;Chemotherapy alone in 6cases,which 1year and 3years OS were 53.6% and 53.6%,respectively;16cases of comprehensive treatment combined radiation and chemotherapy which 1year and 3years OS are 84.6% and 84.6% respectively.There were significant difference between three kinds of treatment model（P=0.027）,and chemotherapy alone had the worst prognosis.Further multivariate analysis using Coxproportional hazard model showed that the course of the disease,B symptoms,EBV-DNA copy number positive,treatment mode closely associated with the prognosis（P were 0.006,0.003,0.010,0.040respectively）.Conclusion：Extranodal NK/T-cell lymphoma,nasal type invasive is strong,the overall prognosis is poor.For early Ann Arbor staging,low risk and limited to the nasal cavity cases,radiotherapy alone curative effect is better.While fo

关 键 词：结外NK/T细胞淋巴瘤 鼻型 肿瘤分期 治疗 预后 

分 类 号：R739.6[医药卫生—肿瘤]