早期鼻腔NK/T细胞淋巴瘤74例放化疗效果及预后因素分析  

Early stage nasal NK/T cell lymphoma： an analysis of efficacy of chemoradiotherapy and prognostic factors in 74 cases

作　　者：鲁萍[1] 兰胜民[1] 郭汝元[1] 

机构地区：[1]山西省肿瘤医院放疗头颈综合科,太原030013

出　　处：《白血病．淋巴瘤》2017年第6期340-344,共5页Journal of Leukemia & Lymphoma

摘　　要：目的 探讨早期鼻腔NK/T细胞淋巴瘤患者放化疗效果和预后因素.方法 回顾性分析2005年1月至2013年11月在山西省肿瘤医院接受治疗的确诊为ⅠE~ⅡE期的鼻腔NK/T细胞淋巴瘤患者74例,其中,单纯放疗28例,单纯化疗36例,同步放化疗10例.36例单纯化疗患者中,25例采用CHOP方案（环磷酰胺＋多柔比星＋长春新碱＋泼尼松）,4例采用DICE方案（地塞米松＋异环磷酰胺＋顺铂＋依托泊苷）,7例采用左旋门冬酰胺酶＋地塞米松＋异环磷酰胺＋甲氨蝶呤＋依托泊苷方案.Ann Arbor分期：Ⅰ期60例,Ⅱ期14例.采用Kaplan-Meier法进行生存分析,比较采用log-rank法,多因素分析采用Cox比例风险模型.结果 74例患者均完成治疗.全组失访10例,死亡24例.全组患者3年生存率72.5%,其中,单纯放疗组为92.7%,单纯化疗组为62.3%,同步放化疗组为79.1%,单纯放疗组与单纯化疗组间差异有统计学意义（χ2=10.676,P〈0.05）,单纯放疗组与同步放化疗组间差异无统计学意义（χ2=2.019,P〉0.05）.接受单纯放疗患者完全缓解率、部分缓解率、病情稳定率、进展率分别为89.3%（25/28）、7.1%（2/28）、3.6%（1/28）、0,接受单纯化疗的患者分别为55.6%（20/36）、25.0%（9/36）、8.0%（3/36）、11.1%（4/36）,接受同步放化疗的患者分别为80.0%（8/10）、10.0%（1/10）、0、10.0%（1/10）;单纯放疗组完全缓解率与单纯化疗组差异有统计学意义（χ2=8.584,P〈0.05）,单纯放疗组与同步放化疗组差异无统计学意义（χ2=0.556,P〉0.05）.单因素分析显示：年龄、美国东部肿瘤协作组（ECOG）评分、B症状、Ann Arbor分期、国际预后指数（IPI）及治疗方法的选择与预后有关.多因素分析结果显示,年龄、ECOG评分及Ann Arbor分期是独立的预后因素（均P〈0.05）.结论 放疗作为早期鼻腔NK/T细胞淋巴瘤的主要治疗手段,能取得较好的近期和远期疗效.年龄、ECOG评分、B症状、Ann AObjective To discuss the therapeutic effect of chemoradiotherapy on 74 patients with early stage nasal NK/T cell lymphoma and their prognostic factors. Methods 74 patients with early nasal NK/T cell lymphoma that were treated in Shanxi Cancer Hospital from January 2005 to November 2013 were analyzed retrospectively. Among them, 28 patients received radiotherapy alone, 10 patients received concurrent chemoradiotherapy and 36 patients received alone. In 36 patients with chemotherapy, 25 cases were treated with CHOP （cyclophosphamide＋doxorubicin＋vincristine＋prednisone）, 4 cases were treated with DICE （dexamethasone ＋ etoposide ＋ cisplatin ＋ isofosfamide） and 7 cases were treated with L-asparaginase ＋dexamethasone＋ifosfamide＋methotrexate ＋ etoposide. According to Ann Arbor classification, 60 patients were stage Ⅰ and 14 patients were stage Ⅱ. Kaplan-Meier test was used for survival analysis, log-rank method was used for single factor analysis, and Cox proportional hazard model was used for multi factor analysis. Results All patients completed the treatment. 24 patients were died. 3-year overall survival （OS） rate was 72.5 %. The OS rate in simple radiotherapy group was 92.7 %, simple chemotherapy group was 62.3%, and the concurrent chemoradiotherapy group was 79.1%. The OS rates in simple radiotherapy and simple chemotherapy groups had statistical difference （χ2 = 10.676, P〈 0.05）, The difference in the simple radiotherapy and concurrent chemoradiotherapy groups was not statistically significant （χ2= 2.019, P〉 0.05）. In radiotherapy alone group, the rates of complete remission （CR）, partial remission （PR）, stable rate and progress rate of disease were 89.3%（25/28）, 7.1%（2/28）, 3.6%（1/28）, and 0;in chemotherapy alone group, they were 55.6 % （20/36）, 25.0 % （9/36）, 8.0 % （3/36）, and 11.1 % （4/36）; in concurrent chemoradiotherapy group, they were 80.0 % （8/ 10）, 10.0 % （1/10）, 0, and 10.0 % （1/10）, respectively. There was s

关 键 词：淋巴瘤 结外NK-T细胞 放射疗法 药物疗法 预后 

分 类 号：R733.1[医药卫生—肿瘤]