Wang Liang, Wang Zhao, Xia Zhong-Jun, Lu Yue, Huang Hui-Qiang, Zhang Yu-Jing
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, People's Republic of China.
Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China.
Tumour Biol. 2015 Sep;36(10):7717-23. doi: 10.1007/s13277-015-3485-0. Epub 2015 May 3.
Previous results about the clinical and prognostic significance concerning CD56 expression status in extranodal NK/T cell lymphoma (ENKTL) are controversial due to a small sample size and the heterogeneity nature of this disease. The complete data of 288 patients with early-stage upper aerodigestive tract ENKTL were retrospectively reviewed. One hundred eighty-three patients (63.5 %) had stage I disease, and the primary tumor site of 204 patients (70.8 %) was in the nasal cavity. Sixty patients (20.8 %) were categorized to CD56-negative ENKTL group. The complete remission rate in CD56-positive ENKTL group was 80.6 %, significantly higher than that in CD56-negative ENKTL group (60.8 %, P = 0.005). At a median follow-up time of 69 months, the 5-year and 10-year progression-free survival (PFS) rate were 52 and 41 %, respectively, and the 5-year and 10-year overall survival (OS) rate were 69 % and 68 %, respectively. Patients with primary tumor site located in the nasal cavity or CD56-positive expression had significantly superior PFS and OS (P < 0.05). In multivariate Cox regression model that included age, Ann Arbor stage, lactate dehydrogenase (LDH) level, primary tumor site, chemotherapy regimens, and CD56 expression status, all these six factors remained to be independent prognostic factors for PFS, and the first five factors were independent prognostic factors for OS, while CD56 expression status had a trend to be independently correlated with OS (P = 0.084). In a subgroup analysis according to primary tumor site location, CD56 expression status significantly correlated with survival outcomes in patients with primary nasal cavity involvement (P < 0.05). In conclusion, in this large cohort of patients with early-stage ENKTL, we found that CD56-negative ENKTL had significantly inferior survival outcomes, indicating CD56-negative ENKTL should be regarded as a distinct phenotype, and optimal treatment strategies need to be evaluated further for this entity.
既往关于结外NK/T细胞淋巴瘤（ENKTL）中CD56表达状态的临床及预后意义的研究结果存在争议，原因在于样本量小以及该疾病的异质性。我们对288例早期上消化道ENKTL患者的完整数据进行了回顾性分析。183例患者（63.5%）为Ⅰ期疾病，204例患者（70.8%）的原发肿瘤部位在鼻腔。60例患者（20.8%）被归类为CD56阴性ENKTL组。CD56阳性ENKTL组的完全缓解率为80.6%，显著高于CD56阴性ENKTL组（60.8%，P = 0.005）。在中位随访时间69个月时，5年和10年无进展生存（PFS）率分别为52%和41%，5年和10年总生存（OS）率分别为69%和68%。原发肿瘤部位位于鼻腔或CD56阳性表达的患者具有显著更优的PFS和OS（P < 0.05）。在包含年龄、Ann Arbor分期、乳酸脱氢酶（LDH）水平、原发肿瘤部位、化疗方案及CD56表达状态的多因素Cox回归模型中，所有这六个因素均为PFS的独立预后因素，前五个因素为OS的独立预后因素，而CD56表达状态与OS有独立相关的趋势（P = 0.084）。在根据原发肿瘤部位进行的亚组分析中，CD56表达状态与原发鼻腔受累患者的生存结局显著相关（P < 0.05）。总之，在这一大型早期ENKTL患者队列中，我们发现CD56阴性ENKTL的生存结局显著较差，表明CD56阴性ENKTL应被视为一种独特的表型，对此实体需要进一步评估最佳治疗策略。
