培门冬酶/左旋门冬酰胺酶治疗结外NK/T细胞淋巴瘤的预后因素分析:多中心回顾性研究  

Analysis of prognostic factors of extranodal NK/T-cell lymphoma treated with pegaspargase/L-asparaginase:a multicenter retrospective study

作　　者：沈子园 陈玺丞 单慧蓉 贾韬 顾伟英 王飞 滕清良[6] 王玲[6] 王春玲[7] 史玉叶[7] 张颢[8] 苗雨青 朱太岗[10] 纪春岩[11] 叶静静[11] 张明智[12] 张旭东[12] 王亮 徐开林 桑威 Shen Ziyuan;Chen Xicheng;Shan Huirong;Jia Tao;Gu Weiying;Wang Fei;Teng Qingliang;Wang Ling;Wang Chunling;Shi Yuye;Zhang Hao;Miao Yuqing;Zhu Taigang;Ji Chunyan;Ye Jingjing;Zhang Mingzhi;Zhang Xudong;Wang Liang;Xu Kailin;Sang Wei(Department of Hematology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China;Department of Epidemiology and Biostatistics,School of Public Health,Anhui Medical University,Hefei 230032,China;Department of Hematology,Shuyang Hospital of Traditional Chinese Medicine,Suqian 223600,China;Department of Hematology,the First People's Hospital of Lianyungang,Lianyungang 222002,China;Department of Hematology,the First People's Hospital of Changzhou,Changzhou 213003,China;Department of Hematology,Taian Central Hospital,Taian 271000,China;Department of Hematology,Huai'an First People's Hospital,Huaian 223000,China;Department of Hematology,the Affiliated Hospital of Jining Medical University,Jining 272000,China;Department of Hematology,Yancheng First People's Hospital,Yancheng 224001,China;Department of Hematology,the General Hospital of Wanbei Coal-Electric Group,Suzhou 234000,China;Department of Hematology,Qilu Hospital of Shandong University,Jinan 250012,China;Department of Hematology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Hematology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]徐州医科大学附属医院血液科,徐州221002 [2]安徽医科大学公共卫生学院流行病与卫生统计学系,合肥230032 [3]宿迁市沭阳县中医院血液科,宿迁223600 [4]连云港第一人民医院血液科,连云港222002 [5]常州第一人民医院血液科,常州213003 [6]泰安市中心医院血液科,泰安271000 [7]淮安市第一人民医院血液科,淮安223000 [8]济宁医学院附属医院血液科,济宁272000 [9]盐城市第一人民医院血液科,盐城224001 [10]安徽皖北煤电集团总医院血液科,宿州234000 [11]山东大学齐鲁医院血液科,济南250012 [12]郑州大学第一附属医院肿瘤科,郑州450052 [13]首都医科大学附属北京同仁医院血液科,北京100730

出　　处：《中华血液学杂志》2023年第8期642-648,共7页Chinese Journal of Hematology

基　　金：江苏省青年医学重点人才(QNRC2016791);江苏省自然科学基金(BK20171181);江苏省科技厅社会发展重点项目(BE2019638)。

摘　　要：目的探索培门冬酶/左旋门冬酰胺酶治疗结外NK/T细胞淋巴瘤(ENKTL)的预后影响因素。方法回顾性分析自2014年3月至2021年4月在淮海淋巴瘤协作组11所医疗中心确诊的656例ENKTL患者的临床资料,将患者按照7∶3随机分为训练集(460例)和验证集(196例)两个队列,分析患者的预后影响因素。建立预后评分系统,比较不同模型的预测性能。结果患者的中位年龄为46(34,57)岁,男456例(69.5%),鼻部受累561例(85.5%)。203例(30.9%)患者采用了以左旋门冬酰胺酶联合蒽环类药物为基础的化疗方案,接受P-GEMOX(培门冬酶+吉西他滨+奥沙利铂)方案治疗患者的5年总生存率优于接受SMILE(甲氨蝶呤+地塞米松+异环磷酰胺+左旋门冬酰胺酶+依托泊苷)方案的患者(85.9%对63.8%,P=0.004)。多因素分析结果显示性别、CA分期、美国东部肿瘤协作组体能状况(ECOG PS)评分、HGB、EB病毒DNA是ENKTL患者预后的独立影响因素(P值均<0.05)。基于本研究筛选出的预后因素的预测性能优于国际预后指数、韩国预后指数和自然杀伤淋巴瘤预后指数。结论性别、CA分期、ECOG PS评分、HGB和EB病毒DNA是接受培门冬酶/左旋门冬酰胺酶治疗的ENKTL患者的预后影响因素。Objective To explore the prognostic factors of extracellular NK/T cell lymphoma(ENKTL)treated with pegaspargase/L-asparaginase.Methods The clinical data of 656 ENKTL patients diagnosed at 11 medical centers in the Huaihai Lymphoma Working Group from March 2014 to April 2021 were retrospectively analyzed.The patients were randomly divided into two groups:a training set(460 cases)and a validation set(196 cases)at 7∶3,and the prognostic factors of the patients were analyzed.A prognostic scoring system was established,and the predictive performance of different models was compared.Results Patients'median age was 46(34,57)years,with 456 males(69.5%)and 561 nasal involvement(85.5%).203 patients(30.9%)received a chemotherapy regimen based on L-asparaginase combined with anthracyclines,and the 5-year overall survival rate of patients treated with P-GEMOX regimen(pegaspargase+gemcitabine+oxaliplatin)was better than those treated with SMILE regimen(methotrexate+dexamethasone+cyclophosphamide+L-asparaginase+etoposide)(85.9%vs 63.8%;P=0.004).The results of multivariate analysis showed that gender,CA stage,the Eastern Cooperative Oncology Group performance status(ECOG PS)score,HGB,and EB virus DNA were independent influencing factors for the prognosis of ENKTL patients(P<0.05).In this study,the predictive performance of the prognostic factors is superior to the international prognostic index,Korean prognostic index,and prognostic index of natural killer lymphoma.Conclusion Gender,CA stage,ECOG PS score,HGB,and EB virus DNA are prognostic factors for ENKTL patients treated with pegaspargase/L-asparaginase.

关 键 词：淋巴瘤 结外NK-T细胞 预后 培门冬酶 天冬酰胺酶 

分 类 号：R733[医药卫生—肿瘤]