Liu P L, Cheng Z X, Lu M P, Zhang L Q, Chen H B
Department of Otolaryngology，the Affiliated Hospital of Yangzhou University，Yangzhou，225001，China.
Department of Otolaryngology，the First Affiliated Hospital of Nanjing Medical University.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Jan;34(1):73-78. doi: 10.13201/j.issn.1001-1781.2020.01.018.
The Clinicopathological characteristics and the reason of misdiagnosis about nasal extranodal NK/T cell lymphoma in head and neck（ENKTL） are analysised to raise awareness and reduce misdiagnosis. One hundred and twenty patients with ENKTL, diagnosed pathologically in head and neck from May 2010 to April 2018, were analyzed retrospectively. All cases were divided into misdiagnosed group and non-misdiagnosed group according to whether there were misdiagnosis and mistreatment before diagnosis. The differences of clinicopathological characteristics between the two groups before and after diagnosis were compared. The differences of overall survival（OS） between the two groups after treatment were also compared. The misdiagnosis rate of this study was 71.7%, and they were misdiagnosed as sinusitis, nasal polyps, upper respiratory tract infection and so on. On the whole, the 1-year OS, 3-year OS and 5-year OS were 77.8%, 65.9% and 49.3% respectively. There was no significant difference in sex, age, first symptom, initial site, B symptom, superficial lymph node enlargement and weight loss between two groups before diagnosis（>0.05）, however, there were significant differences in relative specific signs, hospital grade and time from first visit to definite diagnosis（<0.05）. The proportion of the high-level hospitals in the first visit hospital was significantly lower than that in the non-misdiagnosed group, while the time from the first visit to the final diagnosis was significantly longer than that in the non-misdiagnosed group. There was no significant difference in international prognostic index（IPI） score, expression of Ki-67, therapeutic schedule, chemotherapy regimen for patients receiving chemotherapy, and radiation dose for patients receiving radiotherapy after diagnosis between the two groups（>0.05）, but there was a significant difference in the clinical stages of Ann Arbor between the two groups（<0.05）. The clinical staging of the misdiagnosed group was later than that of the non-misdiagnosed group. The 1-year OS, 3-year OS and 5-year OS were 73.6%, 59.3% and 43.2% in the misdiagnosed group respectively, and 88.2%, 82.4% and 64.2% in the non-misdiagnosed group respectively. The overall survival rate in the misdiagnosis group was lower than that in the non-misdiagnosed group, and the overall survival time was lower than that in the non-misdiagnosed group. However, there was no significant difference in the overall survival rates between the early stage（Ⅰ and Ⅱ） and the advanced stage（Ⅲ and Ⅳ） of Ann Arbor（>0.05）. The non-specific clinical and the complexity of pathological features of ENKTL in head and neck might cause misdiagnosis, which leads to prolonged time from first visit to definite diagnosis, thus results in disease progression, and ultimately may lead to decreased overall survival rate. To avoid the misdiagnosis and early diagnosis is very important.
分析头颈部鼻型结外NK/T细胞淋巴瘤（ENKTL）的临床病理特征及误诊原因，以提高认识并减少误诊。回顾性分析2010年5月至2018年4月在头颈部经病理诊断的120例ENKTL患者。根据诊断前是否存在误诊和误治，将所有病例分为误诊组和非误诊组。比较两组诊断前后的临床病理特征差异。还比较了两组治疗后总生存（OS）的差异。本研究的误诊率为71.7%，误诊为鼻窦炎、鼻息肉、上呼吸道感染等。总体而言，1年、3年和5年总生存率分别为77.8%、65.9%和49.3%。两组诊断前在性别、年龄、首发症状、初始部位、B症状、浅表淋巴结肿大和体重减轻方面无显著差异（>0.05），但在相对特异体征、医院级别和从初诊到确诊时间方面存在显著差异（<0.05）。初诊医院中高级别医院的比例显著低于非误诊组，而从初诊到最终诊断的时间显著长于非误诊组。两组诊断后国际预后指数（IPI）评分、Ki-67表达、治疗方案、接受化疗患者的化疗方案以及接受放疗患者的放疗剂量无显著差异（>0.05），但两组Ann Arbor临床分期存在显著差异（<0.05）。误诊组的临床分期晚于非误诊组。误诊组的1年、3年和5年总生存率分别为73.6%、59.3%和43.2%，非误诊组分别为88.2%、82.4%和64.2%。误诊组的总生存率低于非误诊组，总生存时间也低于非误诊组。然而，Ann Arbor早期（Ⅰ和Ⅱ期）和晚期（Ⅲ和Ⅳ期）的总生存率无显著差异（>0.05）。头颈部ENKTL非特异性的临床及病理特征的复杂性可能导致误诊，从而导致从初诊到确诊时间延长，进而导致疾病进展，最终可能导致总生存率降低。避免误诊及早期诊断非常重要。
