早期低危结外鼻型NK/T细胞淋巴瘤放疗的疗效  

Outcome of radiotherapy for low-risk early-stage patients with extranodal NK/T-cell lymphoma,nasal-type

作　　者：王晓丹 刘欣 吴涛 杨勇 亓姝楠 何侠[3] 张利玲[4] 伍钢[4] 曲宝林 钱立庭 侯晓荣[7] 张福泉[7] 乔学英[8] 汪华 李高峰[10] 朱远[11] 曹建忠[12] 吴君心[13] 朱苏雨 石梅 苏航 张希梅 张会来 黄慧强[19] 张玉晶[20] 宋玉琴 朱军 王颖 李晔雄 Wang Xiaodan;Liu Xin;Wu Tao;Yang Yong;Qi Shunan;He Xia;Zhang Liling;Wu Gang;Qu Baolin;Qian Liting;Hou Xiaorong;Zhang Fuquan;Qiao Xueying;Wang Hua;Li Gaofeng;Zhu Yuan;Cao Jianzhong;Wu Junxin;Zhu Suyu;Shi Mei;Su Hang;Zhang Ximei;Zhang Huilai;Huang Huiqiang;Zhang Yujing;Song Yuqin;Zhu Jun;Wang Ying;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,Affiliated Hospital of Guizhou Medical University/Guizhou Cancer Hospital,Guiyang 550000,China;Department of Radiation Oncology,Jiangsu Cancer Hospital/Nanjing Medical University Affiliated Cancer Hospital,Nanjing 210009,China;Department of Oncology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430023,China;Department of Radiation Oncology,The General Hospital of Chinese People′s Liberation Army,Beijing 100853,China;Department of Radiation Oncology,the First Affiliated Hospital of University of Science and Technology of China/Anhui Provincial Hospital,Hefei 230001,China;Department of Radiation Oncology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Radiation Oncology,Hebei Cancer Hospital/the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Radiation Oncology,Second Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Radiation Oncology,Beijing Hospital,Beijing 100730,China;Department of Radiation Oncology,Zhejiang Cancer Hospital/Cancer Hospital of The University of Chinese Academy of Sciences,Hangzhou 310022,China;Department of Radiation Oncology,Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Radiation Oncology,Fujian Provincial Cancer Hospital/Affiliated Cancer Hospital of Fujian Medical University,Fu

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]贵州省肿瘤医院,贵州医科大学附属肿瘤医院淋巴瘤科,贵阳550000 [3]江苏省肿瘤医院,南京医科大学附属肿瘤医院放疗科,210009 [4]华中科技大学同济医学院附属协和医院肿瘤中心,武汉430023 [5]解放军医学院,解放军总医院第一医学中心放疗科,北京100853 [6]安徽省立医院,中国科学技术大学附属第一医院放疗科,合肥230001 [7]中国医学科学院,北京协和医学院,北京协和医院放疗科,100730 [8]河北省肿瘤医院,河北医科大学第四医院放疗科,石家庄050011 [9]南昌大学第二附属医院放疗科,330006 [10]北京医院放疗科,100730 [11]浙江省肿瘤医院,中国科学院大学附属肿瘤医院放疗科,杭州310022 [12]山西省肿瘤医院,山西医科大学附属肿瘤医院放疗科,太原030001 [13]福建省肿瘤医院,福建医科大学附属肿瘤医院放疗科,福州350014 [14]湖南省肿瘤医院,中南大学湘雅医学院附属肿瘤医院放疗科,长沙410013 [15]西京医院,第四军医大学第一附属医院放疗科,西安710032 [16]解放军总医院第五医学中心,解放军军事医学科学院附属医院淋巴肿瘤科,北京100071 [17]天津医科大学肿瘤医院,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放疗科,300060 [18]天津医科大学肿瘤医院,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淋巴瘤科,300060 [19]中山大学肿瘤防治中心,中山大学肿瘤研究所,中山大学附属肿瘤医院内科,广州510060 [20]中山大学肿瘤防治中心,中山大学肿瘤研究所,中山大学附属肿瘤医院放疗科,广州510060 [21]北京市肿瘤防治研究所,北京大学肿瘤医院淋巴肿瘤科,100142 [22]重庆肿瘤医院放疗科,400000

出　　处：《中华肿瘤杂志》2021年第10期1105-1113,共9页Chinese Journal of Oncology

基　　金：国家重大研发计划(2016YFC0904600);中国医学科学院医学与健康科技创新工程(2016-I2M-1-001)。

摘　　要：目的探讨早期低危结外鼻型NK/T细胞淋巴瘤(ENKTCL)的放疗疗效和失败模式。方法回顾性分析2000—2015年中国淋巴瘤协作组数据库中557例接受放疗的早期低危ENKTCL患者的放疗疗效。全组557例患者中,接受综合治疗427例,单纯放疗130例。采用Kaplan-Meier法计算生存率,Log rank检验分析组间差异,采用标准化死亡比(SMR)比较ENKTCL患者与年龄、性别相匹配的中国健康人群的预期生存,多因素分析采用Cox回归模型。结果全组患者的5年总生存率和5年无进展生存率分别为87.2%和77.2%。患者治疗生存1年后SMR为匹配健康人群的3.59倍(P<0.001),治疗生存4年后SMR为匹配健康人群的1.50倍(P=0.146)。综合治疗与单纯放疗比较未能提高患者的5年总生存率(分别为87.0%和87.4%,P=0.961)和5年无进展生存率(分别为76.1%和80.7%,P=0.129)。全组患者的失败模式以局部失败(11.5%,64/557)和远处失败(10.8%,60/557)为主,区域失败罕见(2.9%,16/557)。全组患者5年局部区域控制率为87.2%,放疗剂量≥50 Gy和<50 Gy患者的5年局部区域控制率(LRC)分别为89.5%和73.7%(P<0.001)。放疗剂量为LRC的独立影响因素(P<0.05)。结论早期低危ENKTCL患者放疗的预后较好,局部区域和远处失败均较低,放疗剂量为LRC的独立影响因素。Objective To evaluate the prognosis and determine the failure patterns after radiotherapy for low-risk early-stage patients with extranodal NK/T-cell lymphoma,nasal-type(ENKTCL).Methods A total of 557 patients from 2000—2015 with low-risk early-stage ENKTCL who received radiotherapy(RT)with or without chemotherapy(CT)from China Lymphoma Collaborative Group were retrospectively reviewed.Among them,427 patients received combined modality therapy,whereas 130 patients received RT alone.Survivals were calculated by Kaplan-Meier method and compared with Log-rank test.Overall survival(OS)was compared with age and sex-matched general Chinese population using expected survival and standardized mortality ratio(SMR).Cox stepwise regression model was used for multivariate analysis.Results The 5-year OS and progression-free survival(PFS)were 87.2%and 77.2%.The SMR was 3.59(P<0.001)at 1 year after treatment,whereas it was 1.50 at 4 years after treatment,without significant difference between ENKTCL group and country-matched general population(P=0.146).Compared with RT alone,CMT did not result in significantly superior 5-year OS(87.0%vs 87.4%,P=0.961)or PFS(76.1%vs 80.7%,P=0.129).Local failure(11.5%,64/557)and distant failure(10.8%,60/557)were the main failure modes,while regional failure was rare(2.9%,16/557).The 5-year locoregional control rate(LRC)was 87.2%for the whole group,with 89.5%for≥50 Gy versus 73.7%for<50 Gy(P<0.001).Radiotherapy dose was an independent factor affecting LRC(P<0.05).Conclusions Radiotherapy achieves a favorable prognosis in patients with low-risk early-stage ENKTCL.The incidence of either locoregional or distant failure is low.Radiation dose still is an important prognostic factor for LRC.

关 键 词：NK/T细胞淋巴瘤 早期低危组 放疗 预后 

分 类 号：R739.62[医药卫生—肿瘤]