摘要
目的 分析区域淋巴结转移范围在Ⅱ期上呼吸消化道结外鼻型NK/T细胞淋巴瘤（UADT-NKTCL）患者中的预后价值。方法 回顾分析1987—2013年间本院初治的97例Ⅱ期UADT-NKTCL患者资料,分析淋巴结转移范围与预后关系。全组患者52例原发鼻腔,45例原发鼻腔外上呼吸消化道。多数患者接受以放疗为主治疗,65例接受放化疗,27例单纯放疗,5例单纯化疗。Kaplan-Meier法计算生存率,Logrank法检验和单因素预后分析,Cox模型多因素分析。结果 全组患者5年OS、PFS分别为57%、49%。单因素和多因素分析都显示伴有下颈（环状软骨下缘水平以下）淋巴结转移的患者预后更差,其中位生存时间仅19.3个月,2、5年OS分别为28%、11%,而未伴有下颈淋巴结受累的Ⅱ期患者5年OS达68%（P=0.000）。治疗模式明显影响预后,综合治疗患者5年OS、PFS分别为64%、52%,显著优于单纯放疗或化疗患者的40%（P=0.006）和42%（P=0.088）。结论 区域淋巴结受累水平是Ⅱ期UADT-NKTCL的独立预后因素,伴有下颈淋巴结受累患者预后很差。
Objective This study aimed to evaluate the prognostic value of regional lymph node spread in patients with stage Ⅱ nasal-type NK/T-cell lymphoma of the upper aerodigestive tract （UADT-NKTCL）. Methods From 1987 to 2013,a total of 97 patients with newly-diagnosed stage Ⅱ UADT-NKTCL were retrospectively reviewed. Primary tumors were located in the nasal cavity （n=52） or extranasal UADT sites （n=45）.The majority of patients were treated with primary radiotherapy. Sixty-five patients were treated with combined modality therapy （CMT）,and 32 patients were treated with radiotherapy alone （n=27） or chemotherapy alone （n=5）.The Kaplan-Meier method was used to calculate the survival rate, and the log-rank test was used for survival difference analysis and monovariate prognostic analysis. The Cox regression model was used to multivariate prognostic analysis. Results The 5-year overall survival （OS） and progression-free survival （PFS） rates for all stage Ⅱ patients were 57% and 49%,respectively. The presence of a lower neck lymph node （defined as extension below the caudal border of the cricoid cartilage） was significantly associated with poor outcomes on univariate analysis and maintained significance on multivariate analysis. The median survival for patients with lower neck lymph node was 19.3 months and the 2-,5-years OS rates were 28% and 11%（P=0.000）.For stage Ⅱ patients,CMT significantly improved survival. The 5-year OS and PFS rates were 64% and 52% for CMT,compared with 40.4%（P=0.006） and 42% for single modality therapy （P=0.088）. Conclusion The level of regional lymph node is a powerful prognostic factor for stage Ⅱ UADT-NKTCL.The involvement of low neck lymph node is significantly associated with poorer survival outcomes.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2017年第6期636-640,共5页
Chinese Journal of Radiation 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（2016-12M-1-001）
