上呼吸消化道外结外鼻型NK/T细胞淋巴瘤临床特征和预后  

Clinical features and treatment outcome of extranodal nasal-type NK/T-cell lymphoma of the extra-upper aerodigestive tract

作　　者：赵雨婷 王颖 亓姝楠 杨勇 何侠[3] 张玉晶[4] 黄慧强[5] 张利玲[6] 伍钢[6] 曲宝林[7] 钱立庭 侯晓荣[9] 张福泉[9] 乔学英[10] 汪华[11] 李高峰[12] 朱远[13] 曹建忠[14] 吴君心[15] 吴涛 朱苏雨[17] 石梅[18] 徐利明 袁智勇 苏航 宋玉琴[21] 朱军[21] 李晔雄 Zhao Yuting;Wang Ying;Qi Shunan;Yang Yong;He Xia;Zhang Yujing;Huang Huiqiang;Zhang Liling;Wu Gang;Qu Baolin;Qian Liting;Hou Xiaorong;Zhang Fuquan;Qiao Xueying;Wang Hua;Li Gaofeng;Zhu Yuan;Cao Jianzhong;Wu Junxin;Wu Tao;Zhu Suyu;Shi Mei;Xu Liming;Yuan Zhiyong;Su Hang;Song Yuqin;Zhu Jun;Li Yexiong(Department of Radiation Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Radiation Oncology,Chongqing University Cancer Hospital&Chongqing Cancer Hospital,Chongqing 400030,China;Department of Radiation Oncology,Jiangsu Cancer Hospital&Jiangsu Institute of Cancer Research,Nanjing 210009,China;Department of Radiation Oncology,State Key Laboratory of Oncology in South China,Sun Yat-sen University Cancer Center Collaborative Innovation Center for Cancer Medicine,Guangzhou 510060,China;Department of Medical Oncology,State Key Laboratory of Oncology in South China,Sun Yat-sen University Cancer Center Collaborative Innovation Center for Cancer Medicine,Guangzhou 510060,China;Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Radiation Oncology,The General Hospital of Chinese People′s Liberation Army,Beijing 100853,China;Department of Radiation Oncology,The Affiliated Provincial Hospital of Anhui Medical University,Hefei 230001,China;Department of Radiation Oncology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(CAMS)and Peking Union Medical College(PUMC),Beijing 100730,China;Department of Radiation Oncology,The Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Radiation Oncology,The Second Affiliated Hospital of Nanchang University,Nanchang 330029,China;Department of Radiation Oncology,Beijing Hospital,National Geriatric Medical Center,Beijing 100730,China;Department of Radiation Oncology,Zhejiang Cancer Hospital,Hangzhou 310022,China;Department of Radiatio

机构地区：[1]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院放疗科,100021 [2]重庆大学附属肿瘤医院,重庆市肿瘤研究所,重庆市肿瘤医院放疗科,400030 [3]江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院放疗科,210009 [4]华南肿瘤学国家重点实验室,肿瘤医学协同创新中心,中山大学肿瘤防治中心放疗科,广州510060 [5]华南肿瘤学国家重点实验室,肿瘤医学协同创新中心,中山大学肿瘤防治中心肿瘤内科,广州510060 [6]华中科技大学同济医学院附属协和医院肿瘤中心,武汉430022 [7]解放军总医院放射治疗科,北京100853 [8]安徽医科大学附属省立医院放疗科,合肥230001 [9]中国医学科学院北京协和医学院北京协和医院放疗科,100730 [10]河北医科大学第四医院放疗科,石家庄050011 [11]江西省肿瘤医院肿瘤放射治疗科,南昌330029 [12]北京医院国家老年医学中心放射治疗科,100730 [13]浙江省肿瘤医院放疗科,杭州310022 [14]山西省肿瘤医院放疗科,太原030013 [15]福建省肿瘤医院放射治疗科,福州350014 [16]贵州省肿瘤医院淋巴瘤科,贵州医科大学附属医院肿瘤科,贵阳550001 [17]湖南省肿瘤医院湘雅医学院附属肿瘤医院放疗科,长沙410013 [18]第四军医大学西京医院放疗科,西安710032 [19]国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津市恶性肿瘤临床医学研究中心天津医科大学肿瘤医院放疗科,300060 [20]解放军总医院第五医学中心肿瘤科,北京100071 [21]恶性肿瘤发病机制及转化研究教育部重点实验室,北京大学肿瘤医院暨北京市肿瘤防治研究所,100142

出　　处：《中华肿瘤杂志》2021年第7期787-794,共8页Chinese Journal of Oncology

摘　　要：目的探讨上呼吸消化道外结外鼻型NK/T细胞淋巴瘤患者的临床病理特征和预后。方法收集2001年11月至2015年12月,中国淋巴瘤协作组数据库中159例原发上呼吸消化道外结外鼻型NK/T细胞淋巴瘤患者的临床资料,分析其临床病理特征、治疗和预后。生存分析采用Kaplan-Meier法和Log rank检验,多因素分析采用Cox回归模型。结果上呼吸消化道外结外鼻型NK/T细胞淋巴瘤多原发于皮肤软组织(106/159,66.7%)和胃肠道(31/159,19.5%)。Ann ArborⅢ~Ⅳ期和乳酸脱氢酶(LDH)升高的患者比例较高,分别为64.2%(102/159)和47.8%(76/159)。全组患者的3年总生存率为43.6%,3年无进展生存率为27.9%。原发皮肤软组织和胃肠道结外鼻型NK/T细胞淋巴瘤患者的3年生存率分别为41.0%和59.4%(P=0.281),3年无进展生存率分别为24.8%和48.3%(P=0.109)。综合治疗较单纯化疗提高了全组患者的3年生存率(58.4%和33.9%,P=0.001)和3年无进展生存率(40.7%和20.7%,P=0.008)。LDH升高、Ann Arbor分期和≥2个结外部位受侵为总生存的独立危险因素(P<0.05),LDH升高和≥2个结外部位受侵为无进展生存的独立危险因素(P<0.05)。失败模式以远处结外器官复发进展为主。结论上呼吸消化道外结外鼻型NK/T细胞淋巴瘤具有独特的临床特征和较差的预后,放疗或手术±化疗较单纯化疗可能提高上呼吸消化道外结外NK/T细胞淋巴瘤患者的疗效。Objective To investigate the clinical features and prognosis of extranodal nasal-type NK/T-cell lymphoma of the extra-upper aerodigestive tract(extra-UADT NKTCL).Methods The clinical data of 159 patients with extra-UADT NKTCL from the China Lymphoma Collaborative Group(CLCG)database between November 2001 and December 2015 were retrospectively analyzed.Kaplan-Meier survival analysis and Log-rank test were used to evaluate the prognosis.The Cox regression model is used for multi-factor analysis.Results Extra-UADT NKTCL commonly occurs in skin and soft tissues(106/159,66.7%)and gastrointestinal tract(31/159,19.5%).The incidences of elevated lactate dehydrogenase(LDH)and Ann ArborⅢ~Ⅳstage were 47.8%(76/159)and 64.2%(102/159),respectively.The 3-year overall survival(OS)and progression-free survival(PFS)rates were 43.6%and 27.9%,respectively.The corresponding OS rates of primary skin/soft tissue site and gastrointestinal tract site were 41.0%and 59.4%(P=0.281),while the PFS rates were 24.8%and 48.3%,respectively(P=0.109).Combined modality treatment improved the 3-year OS of all the patients(58.4%vs 33.9%,P=0.001)and 3-year PFS(40.7%vs 20.7%,P=0.008)when compared with chemotherapy alone.LDH elevation,Ann Arbor synthesising and≥2 junction external bits were intrusive as independent risk factors for total survival(P<0.05),LDH elevation and≥2 junction outer bits were intrusive as independent risk factors for progressionless survival(P<0.05).The distant extranodal dissemination was the primary failure patterns.Conclusions Extra-UADT NKTCL appears to have distinct clinical characteristics and poor outcome.Compared with chemotherapy alone,combined modality treatment may improve the prognosis of patients with extra-UADT NKTCL.

关 键 词：NK/T细胞淋巴瘤 放射治疗 化学治疗 预后 

分 类 号：R739.62[医药卫生—肿瘤]