早期结外自然杀伤/T细胞淋巴瘤的治疗进展  

Advances in the treatment of early extranodal NK/T cell lymphoma

作　　者：张亚矗 吴涛 Zhang Yachu;Wu Tao(Guizhou Medical University,Guizhou 550000,China;Department of Lymphoma,Cancer Hospital of Guizhou Medical University,Guizhou 550000,China)

机构地区：[1]贵州医科大学,贵州550000 [2]贵州医科大学附属肿瘤医院淋巴瘤科,贵州550000

出　　处：《中华实验外科杂志》2024年第10期2399-2402,共4页Chinese Journal of Experimental Surgery

摘　　要：自然杀伤/T细胞淋巴瘤(NKTCL)是一种侵袭性非霍奇金淋巴瘤。鼻型NKTCL最为常见,约占NKTCL的80%以上,根据Ann Arbor分期大多数患者为Ⅰ/Ⅱ期。早期患者的治疗以放疗联合化疗为主,但患者的生存率差异较大,因此传统的分期系统在指导患者治疗及评估预后上存在局限性。PINK、NRI及7联SNP预测标签等预后模型将患者根据危险因素进一步分层,结果表明低危早期患者仅接受放疗便可达到满意的疗效及预后;对于高危早期患者而言,需要放疗联合化疗以提高生存率。基于门冬酰胺酶的化疗方案如改良SMILE、MESA、ESA、GELOX等联合放疗治疗早期患者达到了80%以上的反应率及生存率,但仍存在较为显著的化疗相关毒副作用。靶向药物在NKTCL中逐步得到广泛应用,已有研究表明程序性死亡因子-1(PD-1)抑制剂的加入可提高早期患者疗效,减少化疗相关毒副作用。此外,西达苯胺与化疗药物或PD-1抑制剂联合使用可协同增强抗肿瘤效果,但多用于治疗难治/复发患者,戈利昔替尼作为JAK1-STAT3抑制剂在数例难治/复发NKTCL患者的疗效得到证实,其在早期患者中的疗效还需未来进一步研究。Natural Killer T-cell lymphomas(NKTCL)are aggressive non-Hodgkin lymphoma.Nasal-type NKTCL was the most common,accounting for more than 80%of NKTCL,and most patients were stage I/II according to Ann Arbor staging.Radiotherapy combined with chemotherapy is the main treatment for early stage patients,but the survival rate varies greatly,so the traditional staging system has limitations in guiding the treatment and evaluating the prognosis.Pink,Nri and seven-SNP predictive tagging models further stratified the patients according to the risk factors.The results showed that the low-risk patients in the early stage could achieve satisfactory efficacy and prognosis only by radiotherapy For high-risk early patients,radiotherapy combined with chemotherapy is needed to improve survival.Asparaginase Erwinia chrysanthemi chemotherapy regimens such as modified SMILE,Mesa,ESA,and GELOX have achieved response rates and survival rates of more than 80%for early stage patients,but still have significant chemotherapy-related side effects.Targeted agents are gradually being widely used in NKTCL,and the addition of PD-1 inhibitors has been shown to improve the efficacy in early patients and reduce chemotherapy-related side effects.In addition,cedaranil in combination with chemotherapy drugs or PD-1 inhibitors synergistically enhances antitumor effects,but is mostly used in the treatment of refractory/relapsed patients;The efficacy of golicitinib as a JAK1-STAT3 inhibitor has been demonstrated in several patients with refractory/relapsed NKTCL,and its efficacy in early patients needs further investigation in the future.

关 键 词：早期NK/T细胞淋巴瘤 放疗 化疗 靶向药物 

分 类 号：R733.1[医药卫生—肿瘤]