Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
The Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan Province, China.
PLoS One. 2019 Apr 17;14(4):e0214860. doi: 10.1371/journal.pone.0214860. eCollection 2019.
Extra nodal natural killer/T-cell lymphoma (ENKTL), nasal type is a rare and highly aggressive type of non-Hodgkin's lymphoma (NHL) commonly presented in the nasal cavity or lymphatic system. However, the common causes of mortality in ENKTL remain unclear. We conducted a retrospective population-based cohort study to elucidate the different causes of mortality in ENKTL and illustrate the main causal and associated risk factors leading to death.
The study included patients diagnosed with ENKTL from 1987 to 2014 in the Surveillance, Epidemiology, and End Results (SEER) program. Univariate survival analysis was conducted using Kaplan-Meier analysis, and multivariate analyses were performed using Cox proportional hazards regression model. Competing-risks regression model was applied to estimate specific risks associated with mortality.
The analysis demonstrated increased mortality in males and patients diagnosed at older age and higher disease stage. NHL was the most common cause of mortality in patients with ENKTL, accounting for 74.13% of deaths in the cohort, followed by other malignant cancers, heart diseases, and infection. However, NHL-specific death events were fewer in patients diagnosed with advanced disease stage compared with incidences of death by other causes such as disease of heart and infections. Significant difference was seen between patients diagnosed earlier than 2000, who showed a higher probability of dying from NHL, and those diagnosed later, who showed propensity to die from other malignant tumors and infection. No differences were found when comparing sex or age at diagnosis.
The most common cause of mortality in cases with ENKTL-NT is NHL. The female sex, diagnosis at young age and early stage are associated with improved prognosis. Further, the classification of Ann Arbor stage and year of diagnosis can provide references of specific causes of death, which might help decrease the mortality rate.
结外自然杀伤/T 细胞淋巴瘤（ENKTL），鼻型是一种罕见且高度侵袭性的非霍奇金淋巴瘤（NHL），通常发生在鼻腔或淋巴系统。然而，ENKTL 患者死亡的常见原因仍不清楚。我们进行了一项回顾性基于人群的队列研究，以阐明 ENKTL 患者死亡的不同原因，并阐明导致死亡的主要因果和相关危险因素。
本研究纳入了 1987 年至 2014 年在监测、流行病学和最终结果（SEER）计划中诊断为 ENKTL 的患者。使用 Kaplan-Meier 分析进行单变量生存分析，使用 Cox 比例风险回归模型进行多变量分析。应用竞争风险回归模型估计与死亡率相关的特定风险。
分析表明，男性和年龄较大以及疾病分期较高的患者死亡率增加。NHL 是 ENKTL 患者死亡的最常见原因，占队列中死亡人数的 74.13%，其次是其他恶性肿瘤、心脏病和感染。然而，与其他原因（如心脏病和感染）导致的死亡相比，在诊断为晚期疾病的患者中，NHL 特异性死亡事件较少。与诊断时间早于 2000 年的患者相比，诊断时间晚于 2000 年的患者死于 NHL 的可能性更高，而诊断时间晚于 2000 年的患者死于其他恶性肿瘤和感染的可能性更高。在比较性别或诊断时的年龄时，没有发现差异。
ENKTL-NT 患者死亡的最常见原因是 NHL。女性、年轻和早期诊断与改善的预后相关。此外，Ann Arbor 分期和诊断年份的分类可以为特定死亡原因提供参考，这可能有助于降低死亡率。
