鼻腔NK/T細胞淋巴瘤的療效及預后分析

[摘要] 目的 分析鼻腔NK/T細胞淋巴瘤的療效及預后因素。方法 分析1996年9月～2005年9月本院收治的60例Ⅰ/Ⅱ期鼻腔NK/T細胞淋巴瘤資料。單因素分析采用Kaplan-Meier法，多因素分析運用Cox比例風險模型。結果 全組5年總生存率(OS)和無病生存率(DFS)分別為56.4%與38.6%。達CR與未達CR的5年OS率分別為60.4%及16.0%(P<0.05)。單純化療與綜合治療相比，5年OS率分別為18.8%及56.7%(P<0.05)，5年DFS分別為15.2%和51.4%。單純放療與綜合治療相比，5年OS率為60.2%及56.7%(P>0.05)，5年DFS分別為57.0%及51.4%(P>0.05)。放療后化療和化療后放療的5年OS率及DFS率分別為59.2%及52.6%，和53.6%及47.5%，無統計學意義。多因素分析顯示，B癥狀、CR率、超腔為獨立預后因素。結論 單純化療在早期鼻腔NK/T細胞淋巴瘤療效差。B癥狀，超腔，CR率是判斷預后的指標。

[關鍵詞] NK/T細胞淋巴瘤;放射治療;化學治療;預后

[中圖分類號] R739.62[文獻標識碼] A [文章編號] 1673-9701(2010)04-06-03

Prognostic Factors and Curative Efficacy of Nasal NK/T-cell Lymphoma

LUO YangkunTAN YanFU BinyuWEN Hao

Radiation Therapy Center，Sichuan Provincial Tumor Hospital，Chengdu 610041，China

[Abstract] Objective To analyze the curative efficacy and prognostic factors in 60 cases of primary nasal NK/T-cell lymphoma. Methods From Sept.1996 to Sept.2005， 60 cases of nasal NK/T-cell lymphoma were diagnosed pathologically. Data from these patients were reviewed. Kaplan-Meier methods were applied in single-factor analysis，and the Cox regression model was applied in multivariate analysis. Results The 5-year overall survival(OS)rate and disease free survival(DFS)rate for all patients were 56.4% and 38.6%. The 5-year OS rate for CR and no-CR patients was 60.4% and 16.0%(P<0.05). The 5-year OS rate and DFS rate of chemotherapy alone group and combined therapy group were 18.8% and 15.2%，56.7% and 51.4%，respectively. The 5-year OS rate and DFS rate were 59.2% and 52.6% for radiotherapy followed by chemotherapy，and 53.6% and 47.5% for chemotherapy followed by radiotherapy. The COX regression showed that B symptoms，local tumor invasion out of the nasal cavity andCR rate were independent prognostic factors. Conclusion NK/T-cell lymphoma shows low chemotherapy sensitivity. B symptoms，local tumor invasion out of the nasal cavity and CR rate are independent prognostic factors.

[Key words] Nasal NK/T-cell lymphoma;Radiotherapy;Chemotherapy;Prognosis

NK/T細胞淋巴瘤是惡性淋巴瘤中的少見特殊類型，鼻腔NK/T細胞淋巴瘤是除韋氏環外最常見的結外非霍奇金淋巴瘤，占全部惡性淋巴瘤的2%～10%，以結外侵犯為主，面中線結構是最常累及的部位。目前其治療模式存在爭議。本研究觀察60例早期鼻腔NK/T細胞淋巴瘤患者的治療療效，并分析預后因素。

1材料與方法

1.1臨床資料

收集1996年9月～2005年9月收治的60例Ⅰ/Ⅱ期原發鼻腔NK/T細胞淋巴瘤，均經病理及免疫組化證實。免疫組化檢查包括CD45、CD43、CD45RO、CD2、CD3、CD79、CD20、TIA(T細胞內抗原T-cell intracellular Antigen)和顆粒酶B(Granzyme B)等。所有病例均有一種或多種NK/T細胞抗原陽性，如CD56(+)，CD3(+)，CD45RO(+)或CD2(+)等，但B細胞抗原標志CD19、CD20、CD79陰性。男性42例，女性18例，男女比為2.3∶1。年齡≤60歲47例，>60歲13例，中位年齡45歲。Ann Arbor分期:Ⅰ期38例，Ⅱ期22例。28例有B癥狀。PS評分<2分56例，≥2分4例。LDH升高12例。IPI(國際預后指數international prognostic index，IPI)<2分44例。原發灶局限于鼻腔42例，超出鼻腔18例。……