CAJ | 학술논문

目的探讨不同治疗方法对早期鼻腔NK/T细胞淋巴瘤预后的影响.方法回顾分析15年问85例ⅠE、ⅡE期鼻腔NK/T淋巴瘤放疗及CHOP为主化疗的疗效.单纯化疗(单化组)20例,放疗后±化疗(放化组)17例(单纯放疗11例),化疗后放疗(化放组)48例.生存率计算采用Kaplan-Meier法,并Logrank法检验,Cox回归模型进行多因素分析.结果全组5年生存率为40%,单化纽、放化组和化放组的分别为13%、54%和47%,放化纽和化放组均优于单化组(P=0.030和0.049).ⅠE局限组与超腔组的5年生存率分别为57%与28%(χ2=8.87,P=0.003),ⅡE期的为23%,与ⅠE超腔组相似(χ2=0.19,P=0.664).近期疗效达到完全缓解与未完全缓解的5年生存率分别为58%与12%(χ2=30.68,P=0.000).放疗剂量≤50 Gy与>50 Gy的完全缓解率分别为56%和86%(χ2=6.11,P=0.013),5年无复发生存率分别为89%与84%(χ2=0.36,P=0.551).首程化疗的68例中≤2、3～4、≥5个疗程者分别为18、20、30例,完全缓解率分别为0%、20%、33%(χ2=7.65,P=0.022).首程先化疗且≥3个疗程的50例和先放疗≥40 Gy的17例的完全缓解率分别为28%和88%(χ2=18.75,P=0.000).结节型和溃疡型的完全缓解率放疗均优于化疗(100%:38%,2X=7.92,P=0.005和100%:11%,χ2=14.40,P=0.000).多因素分析显示临床分期和近期疗效是影响预后的独立因素.结论早期鼻腔NK/T细胞淋巴瘤首程应选择50 Gy放疗为宜.对于ⅠE期超腔与ⅡE期应酌情联合化疗,但CHOP方案效果欠佳.
목적 탐토불동치료방법대조기비강NK/T세포림파류예후적영향.방법 회고분석15년문85례ⅠE、ⅡE기비강NK/T림파류방료급CHOP위주화료적료효.단순화료(단화조)20례,방료후±화료(방화조)17례(단순방료11례),화료후방료(화방조)48례.생존솔계산채용Kaplan-Meier법,병Logrank법검험,Cox회귀모형진행다인소분석.결과 전조5년생존솔위40%,단화뉴、방화조화화방조적분별위13%、54%화47%,방화뉴화화방조균우우단화조(P=0.030화0.049).ⅠE국한조여초강조적5년생존솔분별위57%여28%(χ2=8.87,P=0.003),ⅡE기적위23%,여ⅠE초강조상사(χ2=0.19,P=0.664).근기료효체도완전완해여미완전완해적5년생존솔분별위58%여12%(χ2=30.68,P=0.000).방료제량≤50 Gy여>50 Gy적완전완해솔분별위56%화86%(χ2=6.11,P=0.013),5년무복발생존솔분별위89%여84%(χ2=0.36,P=0.551).수정화료적68례중≤2、3～4、≥5개료정자분별위18、20、30례,완전완해솔분별위0%、20%、33%(χ2=7.65,P=0.022).수정선화료차≥3개료정적50례화선방료≥40 Gy적17례적완전완해솔분별위28%화88%(χ2=18.75,P=0.000).결절형화궤양형적완전완해솔방료균우우화료(100%:38%,2X=7.92,P=0.005화100%:11%,χ2=14.40,P=0.000).다인소분석현시림상분기화근기료효시영향예후적독립인소.결론 조기비강NK/T세포림파류수정응선택50 Gy방료위의.대우ⅠE기초강여ⅡE기응작정연합화료,단CHOP방안효과흠가.
Objective To investigate the prognosis of patients with nasal NK/T cell lymphoma receiving different treatment modalities. Methods From 1990 to 2004, 85 patients with stage ⅠE and ⅡE primary nasal NK/T cell lymphomas were retrospectively studied. Twenty patients received chemotherapy of CHOP regimen alone, 11 patients received radiotherapy only, 6 patients received radiotherapy followed by more than 2 cycles of chemotherapy, and 48 patients received more than 2 cycles of chemotherapy followed by radiotherapy. Survival analysis was performed by the Kaplan-Meier method, the difference between groups was evaluated by the Log-rank test, and the Cox regression model was used for multivariate analysis. Results The 5-year overall survival rate (OS) was 40%. The 5-year OS was 57% and 28% for limited stage ⅠE and extended stage ⅠE(X2 =8. 87, P =0. 003), and 23% for stage ⅡE, which was similar to extended stage ⅠE (X2 =0. 19, P-0. 664). The 5-year OS was 13%, 54% and 47% for chemotherapy alone, radiotherapy followed with or without chemotherapy, and chemotherapy followed by radiotherapy, respectively. The last two groups had better OS than chemotherapy alone (P = 0. 030 and 0.049). The 5-year OS was 58% and 12% for patients achieving complete response (CR) and uncomplete response (X2 = 30.68, P = 0. 000).The CR rate was 56% and 86% for radiotherapy of ≤50 Gy and >50 Gy (X2 =6.11, P=0. 013). The corresponding 5-year relapse-free survival rate was 89% and 84% (X2 =0.36, P=0.551). Of 68 patients receiving initial chemotherapy, the CR rate of those who received ≤2, 3-4 and ≥5 cycles was 0, 20%and 3 3 % , respectively (X2 = 7.65 , P = 0. 022) . For 5 0 patients who received ≥ 3 cycles of initial chemotherapy and 17 patients who received initial radiotherapy of ≥40 Gy, the CR rate was 28% and 88%(χ2= 18. 75, P= 0. 000). In patients with pathological nodular and ulcer type, the CR rates with radiotherapy were higher than with chemotherapy (100%: 38%, χ2 = 7.92, P = 0. 005; and 100%: 11%,χ2 = 14.40, P = 0. 000). Multivariate analysis showed that stage and recent effect were the independent prognostic factors. Conclusions The initial radiotherapy with 50 Gy is appropriate for early stage nasal NK/T cell lymphomas. Combined chemotherapy could be used for extended stage ⅠE and ⅡE, but the outcome of CHOP regimen is poor.