晚期非鼻型结外自然杀伤/T 细胞淋巴瘤的临床特征、预后分层和治疗：一项多机构真实世界研究。
Clinical features, prognostic stratification, and treatment of advanced-stage non-nasal type extranodal natural killer/T-cell lymphoma: a multi-institutional real-world study.
机构信息
Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China.
出版信息
Ann Hematol. 2024 Jan;103(1):163-174. doi: 10.1007/s00277-023-05455-4. Epub 2023 Oct 10.
The present study aimed to investigate the clinical features, prognosis, and treatment of advanced-stage non-nasal type extranodal natural killer/T-cell lymphoma (ENKTCL). This real-world study retrospectively reviewed 56 newly diagnosed advanced-stage non-nasal type ENKTCL patients from two large-scale Chinese cancer centers in the last 10-15 years and screened 139 newly diagnosed advanced-stage nasal type ENKTCLs admitted during the same period for comparison. The non-nasal type ENKTCLs exhibited significantly higher Ki-67 expression levels compared to nasal type disease (P = 0.011). With a median follow-up duration of 75.03 months, the non-nasal group showed slightly inferior survival outcomes without statistically significant differences compared to the nasal group (median overall survival (OS): 14.57 vs. 21.53 months, 5-year OS: 28.0% vs. 38.5%, P = 0.120). Eastern Cooperative Oncology Group (ECOG) score ≥ 2 (hazard ratio (HR) = 2.18, P = 0.039) and lactic dehydrogenase (LDH) elevation (HR = 2.44, P = 0.012) were significantly correlated with worse OS in the non-nasal group. First-line gemcitabine-based chemotherapy regimens showed a trend toward slightly improved efficacy and survival outcomes compared to non-gemcitabine-based ones in the present cohort of non-nasal ENKTCLs (objective response rate: 91.7% vs. 63.6%, P = 0.144; complete response rate: 50.0% vs. 33.3%, P = 0.502; median progression-free survival: 10.43 vs. 3.40 months, P = 0.106; median OS: 25.13 vs. 9.30 months, P = 0.125), which requires further validation in larger sample size studies. Advanced-stage non-nasal type patients could achieve comparable prognosis with nasal cases after rational therapy. The modified nomogram-revised index (including age, ECOG score, and LDH) and modified international prognostic index (including age, ECOG score, LDH, and number of extranodal involvement) functioned effectively for prognostic stratification in non-nasal type ENKTCLs.
本研究旨在探讨晚期非鼻型结外自然杀伤/T 细胞淋巴瘤（ENKTCL）的临床特征、预后和治疗。这项真实世界的研究回顾性分析了过去 10-15 年来自中国两家大型癌症中心的 56 例新诊断的晚期非鼻型 ENKTCL 患者，并为比较筛选了同期入院的 139 例新诊断的晚期鼻型 ENKTCL。与鼻型疾病相比，非鼻型 ENKTCL 的 Ki-67 表达水平明显更高（P=0.011）。中位随访时间为 75.03 个月，非鼻型组的生存结果略差，但与鼻型组相比无统计学差异（中位总生存期（OS）：14.57 与 21.53 个月，5 年 OS：28.0%与 38.5%，P=0.120）。Eastern Cooperative Oncology Group（ECOG）评分≥2（风险比（HR）=2.18，P=0.039）和乳酸脱氢酶（LDH）升高（HR=2.44，P=0.012）与非鼻型组的 OS 较差显著相关。在本研究队列中，与非吉西他滨为基础的化疗方案相比，吉西他滨为基础的化疗方案显示出略微改善的疗效和生存结果（客观缓解率：91.7%与 63.6%，P=0.144；完全缓解率：50.0%与 33.3%，P=0.502；无进展生存期：10.43 与 3.40 个月，P=0.106；总生存期：25.13 与 9.30 个月，P=0.125），这需要在更大的样本量研究中进一步验证。经过合理治疗，晚期非鼻型患者可以获得与鼻型病例相当的预后。改良的nomogram 修订指数（包括年龄、ECOG 评分和 LDH）和改良的国际预后指数（包括年龄、ECOG 评分、LDH 和结外受累部位数量）有效地用于非鼻型 ENKTCL 的预后分层。
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