调强放疗联合化疗治疗鼻型NK/T细胞淋巴瘤的疗效及相关分析  

Efficacy and Correlation Analysis of Intensity Modulated Radiotherapy Combined with Chemotherapy for Nasal NK/T-Cell Lymphoma

作　　者：杨攀 陈灿 曾甜 冉凤伟 刘小庆 张艳玲 Yang Pan;Chen Can;Zeng Tian;Ran Fengwei;Liu Xiaoqing;Zhang Yanling(Department of Oncology,The First Hospital Affiliated to AMU(Southwest Hospital),Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院肿瘤科

出　　处：《肿瘤预防与治疗》2019年第10期866-872,共7页Journal of Cancer Control And Treatment

基　　金：军事医学与战创伤救治临床新技术计划项目(编号:SWH2016JSTSYB-35)~~

摘　　要：目的:探讨调强放疗(intensity modulated radiation therapy,IMRT)联合化疗治疗结外NK/T细胞淋巴瘤,鼻型(extranodal NK/T-cell lymphoma,nasal type,ENTCL)疗效及预后影响相关因素分析。方法:回顾性分析2008~2016年我院肿瘤科初治ENTCL患者103例,其中鼻腔型为84例,韦氏环型为19例。分期采用Ann Arbor分期,其中IE期74例,IIE期29例。放疗采用IMRT放疗技术,单纯放疗5例,放化疗98例。观察治疗疗效、分析临床特征与预后关系。结果:中位随访时间45个月,随访率100%。全组完全缓解(complete remission,CR)率为69. 9%,IE期患者为83. 8%,IIE期患者为34. 5%,差异有统计学意义(χ2=24. 07,P <0. 001);单纯放疗患者为100%,放化疗患者为68. 4%,差异有统计学意义(χ2=2. 263,P=0. 133);放疗剂量:≤54Gy的患者为60%,> 54Gy的患者为75%,差异有统计学意义(χ2=2. 471,P=0. 116)。全组5年总生存率(overall survival,OS)和无瘤生存率(disease free survival,DFS)分别为69. 1%、67. 6%;IE、IIE期患者的5年OS分别为81. 5%,34. 8%,差异有统计学意义(χ2=40. 894,P <0. 001),5年DFS分别为79. 5%,17. 5%,差异有统计学意义(χ2=36. 246,P <0. 001)。单因素预后分析显示临床分期、PS评分、IPI评分、B症状、乳酸脱氢酶(lactate dehydrogenase,LDH)水平、首程疗效是否达CR是OS和DFS的影响因素。多因素预后分析显示临床分期、IPI评分、首程疗效达CR、LDH水平与OS有关;分期、IPI评分、首程疗效达CR与DFS有关。结论:IMRT联合含左旋门冬酰胺酶的化疗方案治疗局限期ENTCL疗效较好;临床分期、PS评分、IPI评分、B症状、LDH水平、首程疗效达CR是OS和PFS的影响因素。Objective:To investigate the effects and prognostic factors of intensity modulated radiotherapy(IMRT)com-bined with chemotherapy for extranodal NK/T-cell lymphoma,nasal type(ENTCL).Methods:Retrospective analysis was performed on 103 cases of patients with ENTCL treated in department of oncology in our hospital from 2008 to 2016.There were 84 cases of nasal type and 19 cases of Waldeyer ring type.Ann Arbor staging was adopted.74 cases were in the IE stage and 29 cases were in the IIE stage.IMRT was used for radiation treatment.5 patients received radiotherapy alone and 98 patients received radiochemotherapy.We observed the therapeutic effect and analyzed the relationship between clini-cal features and prognosis.Results:The median follow-up time was 45 months,and the follow-up rate was 100%.The complete remission(CR)rate was 69.9%in all patients.The CR rate in stage IE was 83.8%,and in stage IIE was 34.5%(χ2=24.07,P<0.001).The CR rate of patients receiving radiotherapy alone was 100%,and that of patients receiving radiochemotherapy was 68.4%(χ2=2.263,P=0.133).The CR rate of radiotherapy dose less than 54Gy was 60%,and that of radiotherapy dose more than 54Gy was 75%(χ2=2.471,P=0.116).The 5-year overall survival(OS)rate and disease-free survival(DFS)rate in all patients were 69.1%and 67.6%,respectively.The five-year OS in stage IE and stage IIE patients were 81.5%and 34.8%(χ2=40.894,P<0.001),respectively.The five-year DFS in stage IE and stage IIE patients were 79.5%and 17.5%(χ2=36.246,P<0.001),re-spectively.Univariate prognostic analysis showed that clinical stage,performance status(PS)score,international prognostic index(IPI)score,B symptom,lactate dehydrogenase(LDH)level and CR rate were influencing factors of OS and PFS.Multivariate prognostic analysis revealed that clinical stage,IPI score,LDH level and whether first-stage efficacy was up to CR were related to OS.Stage,IPI score and CR rate were related to DFS.Conclusion:Chemotherapy with L-asparaginase combined with IMRT is effective in the treatment of l

关 键 词：结外鼻型NK/T细胞淋巴瘤 放化疗 左旋门冬酰胺酶 预后 

分 类 号：R733.1[医药卫生—肿瘤] R730.53[医药卫生—临床医学]