Ren Quanguang, Cui Yue, Wang Zhao, Fang Xiaojie, Chen Meiting, Chen Zegeng, Lin Tongyu, Jiang Yongsheng, Huang He
Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Ann Hematol. 2025 Jan;104(1):479-487. doi: 10.1007/s00277-024-06149-1. Epub 2024 Dec 27.
Although different types of prognostic indices have been applied in extranodal NK-/T-cell lymphoma (ENKTL), they are based mainly on clinical characteristics before treatment. Moreover, these methods lack early assessment and tumor metabolic parameters. It remains unclear whether changes in the plasma Epstein-Barr virus DNA (EBVDNA) status and SUVmax after two cycles of chemotherapy may predict disease prognosis. We retrospectively analyzed the clinical records of 119 patients with ENKTL. According to the multivariate analysis, limited stage (LS), interim EBVDNA (I-EBVDNA) negativity and a ≥ 50% decrease in the sum of the SUVmax for the target lesion (DSSTL) were significantly associated with complete remission after two cycles of chemotherapy (p = 0.005, p = 0.016 and 0.026, respectively). LS disease, I-EBVDNA negativity and ≥ 50% DSSTL were strongly associated with prolonged PFS (HR = 2.953, 95% CI 1.433-6.009, p = 0.003; HR = 2.479, 95% CI 1.239-4.958, p = 0.01; and HR = 2.048, 95% CI 1.037-4.405, p = 0.039, respectively). Based on these predictors of PFS, a preliminary scoring system was developed. Patients with scores of 1 and 2/3 had poorer survival outcomes than those with a score of 0 (HR = 2.030, 95% CI 0.816-5.048, p = 0.044, and HR = 2.377, 95% CI 1.663-3.396, p = 0.000, respectively). This scoring system also applied well to overall survival (OS) and appeared to be superior to the revised Ann Arbor staging system (p < 0.001, vs. p = 0.205). By assessing the early response to chemotherapy, interim changes in the SUVmax and I-EBVDNA could be used to predict disease prognosis and better stratify patients into subgroups with different prognoses of ENKTL. Further prospective studies are needed to verify these findings.
尽管不同类型的预后指数已应用于结外NK/T细胞淋巴瘤（ENKTL），但它们主要基于治疗前的临床特征。此外，这些方法缺乏早期评估和肿瘤代谢参数。化疗两个周期后血浆EB病毒DNA（EBVDNA）状态和SUVmax的变化是否可预测疾病预后仍不清楚。我们回顾性分析了119例ENKTL患者的临床记录。根据多因素分析，局限期（LS）、中期EBVDNA（I-EBVDNA）阴性以及靶病灶SUVmax总和（DSSTL）下降≥50%与化疗两个周期后的完全缓解显著相关（分别为p = 0.005、p = 0.016和0.026）。LS疾病、I-EBVDNA阴性和DSSTL≥50%与PFS延长密切相关（HR = 2.953，95%CI 1.433 - 6.009，p = 0.003；HR = 2.479，95%CI 1.239 - 4.958，p = 0.01；HR = 2.048，95%CI 1.037 - 4.405，p = 0.039）。基于这些PFS的预测指标，开发了一个初步的评分系统。评分为1分和2/3分的患者的生存结局比评分为0分的患者差（分别为HR = 2.030，95%CI 0.816 - 5.048，p = 0.044；HR = 2.377，95%CI 1.663 - 3.396，p = 0.000）。该评分系统在总生存（OS）方面也表现良好且似乎优于修订的Ann Arbor分期系统（p < 0.001，对比p = 0.205）。通过评估化疗的早期反应，SUVmax和I-EBVDNA的中期变化可用于预测疾病预后并更好地将ENKTL患者分层为具有不同预后的亚组。需要进一步的前瞻性研究来验证这些发现。
