State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China.
Center for Cancer Precision Medicine, CAMS and PUMC, Beijing, China.
Cancer Med. 2018 Dec;7(12):5952-5961. doi: 10.1002/cam4.1849. Epub 2018 Oct 24.
The purpose of this study was to determine the curability of early-stage extranodal nasal-type NK/T-cell lymphoma (NKTCL) in response to radiotherapy and non-anthracycline-based chemotherapy in elderly patients.
In this multicenter study from the China Lymphoma Collaborative Group (CLCG) database, 321 elderly patients with early-stage NKTCL were retrospectively reviewed. Patients received radiotherapy alone (n = 87), chemotherapy alone (n = 59), or combined modality therapy (CMT, n = 175). Patients were classified into low- or high-risk groups using four prognostic factors. Observed survival in the study cohort vs expected survival in age- and sex-matched individuals from the general Chinese population was plotted using a conditional approach and subsequently compared using a standardized mortality ratio (SMR).
Radiotherapy conveyed a favorable prognosis and significantly improved survival compared to chemotherapy alone. The 5-year overall survival (OS) and progression-free survival (PFS) were 61.2% and 56.4%, respectively, for radiotherapy compared with 44.7% and 38.3%, respectively, for chemotherapy alone (P < 0.001). The combination of a non-anthracycline-based chemotherapy regimen and radiotherapy significantly improved PFS compared to combination of an anthracycline-based chemotherapy regimen and radiotherapy (71.2% vs 44.2%, P = 0.017). Low-risk patients following radiotherapy (SMR, 0.703; P = 0.203) and high-risk patients who achieved PFS at 24 months (SMR, 1.490; P = 0.111) after radiotherapy showed survival equivalent to the general Chinese population.
Our findings indicate a favorable curability for this malignancy in response to radiotherapy and non-anthracycline-based chemotherapy, providing a risk-adapted follow-up and counsel scheme in elderly patients.
本研究旨在确定放疗和非蒽环类药物为基础的化疗对老年早期结外鼻型 NK/T 细胞淋巴瘤（NKTCL）患者的疗效。
本研究回顾性分析了中国淋巴瘤协作组（CLCG）数据库中 321 例老年早期 NKTCL 患者。患者接受单纯放疗（n=87）、单纯化疗（n=59）或联合治疗（CMT，n=175）。根据 4 个预后因素将患者分为低危或高危组。采用条件法绘制研究队列的观察生存情况与按年龄和性别匹配的中国一般人群预期生存情况，并采用标准化死亡率比（SMR）进行比较。
与单纯化疗相比，放疗可带来更好的预后并显著提高生存率。放疗组 5 年总生存（OS）率和无进展生存（PFS）率分别为 61.2%和 56.4%，而单纯化疗组分别为 44.7%和 38.3%（P<0.001）。非蒽环类药物联合化疗与放疗联合蒽环类药物联合化疗相比，PFS 显著改善（71.2% vs 44.2%，P=0.017）。放疗后低危患者（SMR，0.703；P=0.203）和 24 个月时达到 PFS 的高危患者（SMR，1.490；P=0.111）的生存情况与中国一般人群相当。
我们的研究结果表明，放疗和非蒽环类药物为基础的化疗对这种恶性肿瘤具有良好的疗效，可为老年患者提供风险适应的随访和咨询方案。
