Analysis Of The Therapeutic Effects And Prognostic Factors Of Early-stage Extra-nodal Nasal Type NK/T-cell Lymphoma

Objective The clinical data,treatment modes and prognostic factors of patients was collected with early-stage extra-nodal nasal type NK/T-cell lymphoma.Meanwile,the relationship between different treatment modes and long-term survival,as well as the correlation between risk factors and prognosis was also retrospectively analyzed.The results could provide the evidence for the well treatment.Methods The relationship between different treatment modes and long-term survival and prognostic factors was analyzed.By the way,the correlation between treatment modes and prognostic factors and long-term survival was compared by collecting the clinical data of early-stage of ENKTL patients who met the inclusion and exclusion criteria from June 2012 to June 2019 in Tumor Hospital of General Hospital of Ningxia Medical University.Results A total of 55 patients of early-stage extra-nodal nasal NK/T-cell lymphoma were collected in this study,including 39 males and 16 females(2.4:1 for ratio of males to females).The median age was 55 years old(23-79 years).The median follow-up time was 29months(1-99 months).Among the patients in the whole group,34 patients survived and 21died(the death rate was 38.2%).The number of patients with 1,3,5-years survival was 36,24 and 13.The OS in 1,3 and 5 years was 72.9%,64.5% and 56.7% respectively.All patients were divided into two groups: one group was stage Ⅰ patients without risk factors,and the other group was stage Ⅰ patients with risk factors and stage Ⅱ patients.Seven patients in stage Ⅰ group without factors were treated with radiotherapy alone.The effects after radiotherapy reached CR(100%)of whole patients and the total effective rate was 100%,in addition the median survival time was not reached.Moreover,there were 48 patients in stage Ⅰ(24 cases)and stage Ⅱ(24 cases),including 3 cases with chemotherapy alone,30 cases with radiotherapy alone and 15 cases with combined treatment(6 cases with radiotherapy follow by chemotherapy(RT+CT),5 cases with chemotherapy followed by radiotherapy(CT+RT)and 4cases with sandwich chemoradiotherapy).In this group,21 patients achieved CR(21/48,43.75%),27 patients did not achieve CR(27/48,56.25%).Compared with the non CR group,the 5-year OS was 65.1% vs.30.3%(P = 0.000)and the 5-year PFS was 67.9% vs.31.2%(P =0.000)in the CR group.Comparison between different treatment methods of stage Ⅰ patients with risk factors and stage Ⅱ patients: Chemotherapy compared with radiotherapy alone and combined treatment,the 5-year OS was 0%,44.0%,84.6%(P =0.026),and the 5-year PFS was 0%,44.5%,85.6%(P =0.021).In the combined treatment group,the 2-year OS of sequential modalities(RT+CT)versus radiotherapy alone was 100% vs.54.2%(P = 0.027),and there was statistically significant.The 2-year OS of sequential modalities(CT+RT)versus radiotherapy alone was66.7% vs.54.2%(P = 0.405),while the 2-year OS of sandwich chemoradiotherapy versus radiotherapy alone was 75.0% vs.54.2%(P = 0.402),there was no statistically significant(P > 0.05),but it had survival tendency in 2-year OS.There was no statistically significant in2-year OS of each treatment method of the combined treatment,sequential sequential modalities(RT+CT)had better survival tendency in 2-year OS compared with other treatment methods.Univariate analysis showed that ECOG score(P =0.01),LDH(P =0.001),β2microglobulin(P =0.033),EBV DNA(P =0.044),primary tumor invasion(P =0.012),treatment methods(P =0.026)and the first course efficacy(P =0.000)was important factors influencing the prognosis of early-stage ENKTL.There was statistically significant about the influence on the long-term survival of patients(P <0.05).Multivariate analysis showed that treatment methods,first stage efficacy,LDH and primary tumor invasion were the independent factors,which was affecting the prognosis of early-stage ENKTL.According to the prognostic model(KPI,PINK,PINK-E and NRI)evaluating the patients with risk factors in stage Ⅰ and stage Ⅱ.The patients were divided into low-risk group and high-risk group,and the impact of each prognostic model classification on long-term survival was evaluated.The results showed that the three prognostic models of KPI score,PINK score and PINK-E score could not well distinguish early-stage patients with high-risk(P > 0.05).However,The NRI score after early-stage adjusted could distinguish high-risk patients,which was correlated with prognosis(P = 0.012).Conclusion 1.For stage Ⅰ patients without risk factors of ENKTL,radiotherapy alone could achieve good therapeutic effects.2.For stage Ⅰ patients with risk factors and stage Ⅱ patients of ENKTL,combined treatment was better than radiotherapy alone and chemotherapy alone.However,sequential modalities(RT+CT)had batter advantage outcomes than other treatment methods in the combined treatment group.3.Univariate analysis showed that ECOG score,LDH level,β2 microglobulin,EBV-DNA,primary tumor invasion,treatment methods and first stage efficacy were important factors affecting the prognosis of ENKTL.Multivariate analysis showed that treatment methods,the first course efficacy,LDH and primary tumor invasion were independent prognostic factors that affecting the prognosis of ENKTL.4.The NRI score after early-stage adjusted could well distinguish high-risk patients,which could and guide treatment.