Analysis Of Clinical Features?diagnosis And Prognosis Of 84 Patients Of Extranodal NK/T Cell Lymphoma

ObjectiveExtranodal NK/T cell lymphoma is a rare subtype of non-Hodgkin's lymphoma.It is aggressive and poor prognosis.The vascular invasion is the main pathological features.EB virus infection is closely related to the clinical characteristics and prognosis of significant heterogeneity.The aim of this study was to investigate the clinical characteristics,treatment and prognostic factors of extranodal NK/T cell lymphoma.Through the retrospective analysis of the relationship between clinical factors and prognosis,analysis of NK/T cell lymphoma response to treatment and clinical outcome of the relevance of EB virus in the development of NK/T cell lymphoma important role.By comparing the treatment model,the relevance of the treatment regime and efficacy,to further explore the principles of its treatment,to explore a NK/T cell lymphoma treatment of new models to better guide the treatment.ContentThe clinical data of patients with extranodal NK/T cell lymphoma from June 2006 to June 2016(including sex,age,B symptom,IPI score,ECOG score,LDH levels,plasma EBV-DNA copies,HB level,ALB level,bone marrow biopsy,lymph node invasion,Ki-67 positive rate,treatment mode,treatment regime,efficacy evaluation).MethodsThe patients were treated with chemotherapy alone,sequential chemoradiotherapy group and comprehensive treatment group.The patients were treated with anthracycline,anthracycline+L-asparaginase and non-anthracycline+L-asparaginase,respectively.The main observation indicators were complete remission rate(CRR),objective response rate(ORR),overall survival(OS)rate and progression-free survival(PFS)rate.Univariate analysis is included age,sex,B symptom,IPI score,general status(ECOG score),lymph node invasion,bone marrow invasion,Ann Arbor stage,serum lactate dehydrogenase(LDH)level,peripheral plasma EBV-DNA copies,HB level,serum albumin(ALB),Ki-67 positive rate,treatment mode,treatment regime,first-course mitigation and other clinical prognostic factors.The survival curves were plotted by Kaplan-Meier method.Log-rank test was used to analyze the survival rate of the patients.The descriptive analysis was performed by chi-square test.The COX model was used to analyze multivariate analysis,P <0.05 for the difference was statistically significant.ResultThe median age of the group was 41 years old;male: female ratio is 2.1: 1;primary nasal cavity in 68(80.9%)cases;regional lymph node involvement in 38(45.2%)cases;bone marrow invasion in 4(4.8%)cases;IPI?2 score in 32(38.1%)cases;ECOG?2 score in 33(39.2%)cases;8(9.5%)cases in stage?E,40(47.6%)cases in stage IIE,6(7.1%)casesin stage ?E,30(35.7%)cases in stage ?E;16(19%)cases with elevated LDH level?245U/L;42(50%)cases of ALB <40g/L;the Ki-67 positive in 59(70.3%)cases;EBV positive in 45(53.5%)cases;There were 31 cases(36.9%)of chemotherapy,41 cases(48.8%)of cheomoradiotherapy and 12 cases(14.3%)of comprehensive treatment;29(34.5%)cases based anthracycline,33(39.3%)cases based anthracycline+L-asparaginase,22(26.2%)cases based non-anthracycline + L-asparaginase-based.A total of 84 patients with extranodal NK/T cell lymphoma with complete clinical data were collected,with overall survival(OS)and progression free survival(PFS)of 58.9% and 52.1%,respectively.The CR/CRu group compare with non-CR/CRu group,5-year OS rate was 81.9% and 26.3% respcetively,5 years PFS rate was 72.2% and 23.3% respcetively.The efficacy of chemotherapy is 13(41.9%)cases CR,4(12.9%)cases PR,CRR 41.9% and ORR 54.8%.The efficacy of radiochemotherapy is 30(73.2%)cases CR,6(14.6%)cases PR,CRR 41.6%,ORR 66.7%.The 5-year OS rates were 46%,72.3% and 44%(P = 0.015),respectively.The PFS rates were 46%,64.7% and 22.5%(P = 0.026),respectively.The efficacy of anthracycline-based therapy was 14%(48.3%)CR,2(6.9%)PR,CRR 48.2%,ORR 55.1%.The efficacy of anthracycline + L-asparaginase was 17(51.5%)cases CR,8(24.2%)cases PR,CRR 51.5% and ORR 86.2%.The efficacy of non-anthracycline + L-asparaginase was 17(77.3%)cases CR,3(13.6%)cases PR,CRR77.2% and ORR90.9%.Among them,the higher ORR was obtained by non-anthracycline combined with L-asparaginase statistical differences(P = 0.016).The 5-year PFS rates were 37%,56.7% and 74.7%(P = 0.038),respectively.The 5-year OS rates were 48.3%,59.8% and 73.4%(P = 0.115)respectively.Univariate analysis showed that anemia,the copy number of EBV-DNA,LDH level,IPI score,ECOG score,Annbor stage,complete remission after the initial therapy were statistically significant for both OS and PFS of the patients,and chemotherapy regimens only statistically significant for PFS.Multivariate analysis showed that complete remission after the initial therapy,LDH level,ECOG,and PFS were statistically significant for both OS and PFS in patients with NK/T cell lymphoma.conclusion1.Extranodal NK / T cell lymphoma is a highly invasive,poor prognosis of malignant tumors;2.The chemoradiotherapy treatment model can significantly improve the therapeutic effect of CRR and ORR and survival of patients,3.Non-anthracycline combined with L-asparaginase-based chemotherapy regimen significantly improve the therapeutic effect of ORR,is the future selection.4.Complete remission after the initial therapy,LDH level,ECOG,and PFS were statistically significant for both OS and PFS in patients with NK/T cell lymphoma.By improving the first-course mitigation,early use of reasonable and effective first-line treatment program,as soon as possible to achieve complete remission,help to improve the prognosis of extranodal NK/T lymphoma.5.Evaluation of plasma EBV-DNA levels before treatment can help to assess and predict the prognosis of patients.