| Objective:Radiotherapy is the cornerstone of the first-line treatment of early-stage extranodal NK/T-cell lymphoma(ENKTCL).In the past decade,the treatment of early-stage ENKTCL has gradually developed from anthracycline-based chemotherapy to non-anthracycline-based chemoradiotherapy.The prognosis of early-stage ENKTCL patients has been improved.In the real world,the majority of patients with early-stage ENKTCL received radiotherapy after induction chemotherapy.At present,there are few studies on ENKTCL with poor prognosis and resistance to induction chemotherapy.This study will analyze the prognosis and failure mode of early-stage ENKTCL patients with chemotherapy resistance,compare the efficacy of induction chemotherapy with different chemotherapy regimens,determine the optimal number of radiotherapy cycles for patients with different chemotherapy reactions,and compare the failure mode of patients with different chemotherapy regimens and different chemotherapy reactions.Methods:This retrospective study was conducted on the early ENKTCL patients who received salvage radiotherapy after partial response(PR)or stable disease(SD)or progressive disease(PD)after initial chemotherapy in China Lymphoma Collaborative Group(CLCG)database.The primary end points were overall survival(OS),progress free survival(PFS),local recurrence free survival(LRRFS)and distant metastasis free survival(DMFS).Kaplan Meier method was used to calculate the 5-year OS and PFS,and log rank method was used to analyze and compare the survival curves among different groups.Chi square test,Kruskal Wallis rank test or Fisher test were used to compare the categorical variables.Multivariate Cox regression model was used to analyze the independent prognostic factors of OS,PFS,LRRFS and DMFS.Propensity score matching(PSM)analysis was performed to reflect the randomized study design and generate comparable study groups.Multivariate Cox proportional hazard regression model and restricted cubic spline(RCS)were used to determine the optimal cut-off value of survival difference in induction chemotherapy cycle.Results:5-year OS rate and 5-year PFS rate were 65.7%and 56.3%respectively.The OS,PFS and DMFS of PR patients receiving the new chemotherapy regimen based on non-anthracycline drugs were better than those of PR patients receiving the old chemotherapy regimen;The LRRFS of the new scheme is better than that of the old scheme,but it is not significant;For the patients with SD/PD,there was no significant difference in the prognosis between the new and old chemotherapy regimens.The OS of early(≤3 cycles of induction chemotherapy)and delayed radiotherapy(>3 cycles)were similar in patients with PR after induction chemotherapy.Compared with advanced radiotherapy,early radiotherapy has significantly better PFS and lower risk of disease progression.For patients with SD/PD after induction chemotherapy,no matter whether the new regimen is adjusted or not,there is no significant difference in OS prognosis between groups with different cycles of induction chemotherapy.Patients receiving early radiotherapy(≤3 cycles of induction chemotherapy)have a better PFS trend than those receiving advanced radiotherapy,but it is not significant.Conclusion:The results of this study show that the overall survival of patients who received salvage radiotherapy after induced chemotherapy resistance is poor.The prognosis of PR patients after the new-scheme chemotherapy was better than that of the old ones.After the new-scheme chemotherapy,the early radiotherapy was better than the advanced radiotherapy.However,for the patients with SD or PD after induced chemotherapy,the effect of the new and old schemes is not different.Long-term chemotherapy shows no advantage in improving prognosis,so radical radiotherapy should be added. |
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