Clinical features and prognostic analysis of extranodal nasal type NK/T cell lymphoma / 白血病·淋巴瘤

ABSTRACT

Objective:To investigate the clinical features, treatment methods and prognostic factors of extranodal nasal type NK/T lymphoma (ENKTL).Methods:The clinical data of 45 patients treated in Renmin Hospital of Wuhan University from January 2013 to June 2019 were retrospectively analyzed. Short-term efficacy was compared among low-risk, medium-risk and high-risk three groups according to PINK score. According to the treatment methods, the patients of stage Ⅰ-Ⅲ were divided into radiotherapy group and radiotherapy+ chemotherapy group. Chi-square test was used to compare the treatment outcomes. The effects of diagnosis time, clinical staging, symptom B, erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH), Ki-67, prognostic index of NK lymphoma (PINK) and treatment methods on overall survival (OS) and progression-free survival (PFS) were analyzed by using Kaplan-Meier method, log-rank test was used for univariate analysis, and Cox proportional hazard model was used for multivariate prognostic analysis.Results:The median age of 45 patients was 51 years old. There were 39 cases (86.7%) of stage Ⅰ-Ⅱ, 4 cases (8.9%) of stage Ⅲ, 2 cases(4.4%) of stage Ⅳ. The median time from first onset to diagnosis was 3.0 months (1.0-36.0 months), and serum EBV-DNA positive rate was 95.6% (43/45). The complete remission (CR) rate and progression of the disease (PD) rate were statistically different of different risk groups ( χ2 = 10.952, P < 0.01; χ2 = 12.217, P = 0.002). Among 43 patients of stage Ⅰ-Ⅲ, there were 11 patients in the radiotherapy alone group, including 4 cases (36.3%) of CR, 3 cases (27.3%) of partial remission (PR), 4 cases (36.4%) of PD; and 32 patients in the chemotherapy combined with radiotherapy group, including 23 cases (71.9%) of CR, 4 cases (12.5%) of PR, 5 cases (15.6%) of PD. The difference in CR rate of both groups was statistically significant ( χ2 = 4.418, P = 0.036). Univariate analysis suggested that PINK score and B symptom were related to OS ( χ2 = 8.140, P = 0.017; χ2 = 5.545, P = 0.019). PINK score and clinical staging were associated with PFS ( χ2 = 12.517, P = 0.002; χ2 = 10.016, P = 0.002); Cox multivariate analysis indicated that clinical staging was an independent influencing factor of PFS ( HR = 4.104, 95% CI 1.571-10.725, P = 0.004). Conclusions:ENKTL with specific location has longer clinical diagnosis time, and the positive rate of EBV-DNA is high. The patients with B symptom and high PINK score have poor OS, and patients with late clinical staging and high PINK score have short PFS. Clinical staging is considered as an independent factor affecting PFS. The PINK score risk stratification has a guiding significance in the short-term efficacy evaluation, and the chemotherapy combined with radiotherapy can increase CR rate for patients less than stage Ⅳ.