CAJ | 학술논문

目的了解非上呼吸消化道原发NK/T细胞淋巴瘤(NUAT-NKTCL)患者的临床特征及生存情况.方法收集44例NUAT-NKTCL患者的临床资料,对其临床特征、疗效及生存进行相关性分析.结果 44例患者中男31例,女13例,中位年龄39(15～ 82)岁,Ⅲ/Ⅳ期者27例(61.4％).就诊时主要症状为皮肤肿物(21/44)、腹痛(11/44)、睾丸肿大(3/44)及间断咳嗽(2/44)等.存在B症状者28例(63.6％),ECOG评分≥2分者12例(27.3％),IPI评分≥3分者18例(40.9％),LDH升高者占48.8％(21/43).全组患者均接受化疗为主的治疗,中位随访13.5(0.3～ 1210)个月,共有32例患者死亡,中位生存时间为16个月,1年总生存率为54.1％.按照一线治疗方案分组:CHOP或CHOPE方案治疗组26例,完全缓解(CR)5例(19.2％),其中有19例患者接受左旋门冬酰胺酶(L-ASP)为主的挽救化疗,9例(47.7％)获CR,中位随访时间为11个月,中位生存时间为13个月 ;L-ASP为主的方案一线治疗组18例,CR 10例(55.6％),中位随访时间为15个月,中位生存时间为16个月.后者较前者CR率提高(P=0.015),但两组患者总生存时间差异无统计学意义(P=0.774)结论 NUAT-NKTCL侵袭性强,患者起病时分期晚.与传统方案比较采用L-ASP为主的方案可提高NUAT-NKTCL患者的疗效,但其长期生存与上呼吸消化道原发患者相比仍不理想,需要探索更为有效的治疗策略.
목적 료해비상호흡소화도원발NK/T세포림파류(NUAT-NKTCL)환자적림상특정급생존정황.방법 수집44례NUAT-NKTCL환자적림상자료,대기림상특정、료효급생존진행상관성분석.결과 44례환자중남31례,녀13례,중위년령39(15～ 82)세,Ⅲ/Ⅳ기자27례(61.4％).취진시주요증상위피부종물(21/44)、복통(11/44)、고환종대(3/44)급간단해수(2/44)등.존재B증상자28례(63.6％),ECOG평분≥2분자12례(27.3％),IPI평분≥3분자18례(40.9％),LDH승고자점48.8％(21/43).전조환자균접수화료위주적치료,중위수방13.5(0.3～ 1210)개월,공유32례환자사망,중위생존시간위16개월,1년총생존솔위54.1％.안조일선치료방안분조:CHOP혹CHOPE방안치료조26례,완전완해(CR)5례(19.2％),기중유19례환자접수좌선문동선알매(L-ASP)위주적만구화료,9례(47.7％)획CR,중위수방시간위11개월,중위생존시간위13개월 ;L-ASP위주적방안일선치료조18례,CR 10례(55.6％),중위수방시간위15개월,중위생존시간위16개월.후자교전자CR솔제고(P=0.015),단량조환자총생존시간차이무통계학의의(P=0.774)결론 NUAT-NKTCL침습성강,환자기병시분기만.여전통방안비교채용L-ASP위주적방안가제고NUAT-NKTCL환자적료효,단기장기생존여상호흡소화도원발환자상비잉불이상,수요탐색경위유효적치료책략.
Objective To analyze clinical features and outcomes of non-upper aerodigestive tract NK/T-cell lymphoma (NUAT-NKTCL).Methods Clinical data of 44 patients with NUAT-NKTCL diagnosed at Peking University Cancer Hospital between 1999 and 2013 were retrospectively analyzed.Results Of the 44 patients,there were 31 males and 13 females with a median age of 39 years (range,15 to 82 years).27 patients (61.4％) were stage Ⅲ/Ⅳ,28(63.6％) with B symptoms,12(27.3％) ECOG≥2,18 (40.9％) IPI score≥3,and 48.8％ patients had elevated serum lactate dehydrogenase.The common primary sites were skin (21/44,47.2％) and intestinal tract (11/44,25.0％).All the 44 patients received systemic chemotherapy.After a median follow-up of 13.5 months (range,0.3-121.0 months),32 patients died,and the median overall survival (OS) was 16 months with l-year OS rate as 54.1％.CR rate of the 26 patients received CHOP or CHOPE regimens as the firstline chemotherapy was 19.2％ (5/26).Then L-asparaginase(L-ASP)-based regimens were used for salvage treatment,with CR rate of 47.7％ and the median OS of 13 months.CR rate of the other 18 patients received L-ASP-based regimens in the firstline therapy was 55.6％ (10/18) with the median OS of 16 months.Using L-ASP in firstline treatment obviously improved CR rate (P=0.015),but did not affect OS (P=0.774).Conclusions Although L-ASP improved the efficacy of NUAT-NKTCL,but the prognosis remained dismal.Thus,more effective treatment strategies are required for NUAT-NKTCL.