| ObjectiveThe aim of this study is to evaluate the prognosis and determine the failure pattern after radiotherapy for patients with early-stage extranodal NK/T-cell lymphoma,nasal-type(ENKTCL),analyze the effect of sequence of radiotherapy(RT)and chemotherapy(CT),and provide a quantitative evaluation method for individualized combination of RT and CT.Materials and Methods.The China Lymphoma Collaborative Group(CLCG)collected a large cohort of 3353 previously untreated patients with ENKTCL from January 2000 to September 2019 from 21 hospitals.Of them,2843 patients with stage Ⅰ/Ⅱ ENKTCL were identified.In the first part,the clinical data of 1567 patients with early-stage ENKTCL who received RT with or without non-anthracycline(ANT)-based CT were retrospectively analyzed.446 patients received RT alone,whereas 1121 patients received combined modality therapy(CMT)with a combination of RT and CT.In the second part,the clinical data of 2008 patients with stage I/II ENKTCL receiving RT and CT were analyzed.388 patients received RT followed by CT,whereas 1620 patients received CT followed by RT.Survivals were calculated by Kaplan-Meier method.Multivariate Cox proportional hazard model was used for selection and identification of independent prognostic factors.Cox proportional hazard prediction model was constructed and used to predict the individual 5-year mortality of all patients,and to determine the optimal treatment strategy for each patient.ResultsIn the first part,the 5-year local regional control rate(LRC),progression-free survival(PFS)and overall survival(OS)for RT alone were 85.6%(95%CI,81.5～89.9%),63.0%(95%CI,58.0～68.50),and 73.7%(95%CI,69.0～78.8%),respectively.The 5-year LRC,PFS and OS for CMT were 84.6%(95%CI,81.4～87.8%),62.6%(95%CI,59.0～66.5%),76.6%(95%CI,73.5～79.8%)respectively.Compared with RT alone,CMT significant improved OS(HR=1.48,95%CI 1.19-1.85;P=0.001),but there was no significant difference in LRC(HR=0.96,95%CI 0.68-1.34;P=0.801)and PFS(HR=1.15,95%CI 0.95-1.39;P=0.146)between two treatment groups.The 5-year predicted local failure rate(14.5%vs.14.7%),progression rate(35.4%vs.36.4%)and mortality(20.8%vs.29.1%)of CMT for all patients was lower than that of RT alone.In the second part,the 5-year LRC,PFS and OS were 85.6%(95%CI,81.5～89.9%),63.0%(95%CI,58.0～68.5%),and 73.7%(95%CI,69.0～78.8%)for RT followed by CT,compared with 81.4%(95%CI,79.0～83.9%;HR=0.74,95%CI 0.54～1.02;P=0.066),57.5%(95%CI,54.8～60.4%;HR=0.88,95%CI 0.73～1.05;P=0.162),69.5%(95%CI,66.9～72.2%;HR=0.84,95%CI 0.68～1.05;P=0.133)for CT followed by RT,respectively.The 5-year local failure rate(13.3%vs.18.6%),progression rate(36.1%vs.40.9%)and mortality(24.9%vs.28.8%)of RT followed by CT for all patients was lower than that of CT followed by RT.The independent prognostic factors(age,gender,PTI,ECOG score,LDH,Ann Arbor stage)had different effects on the prognosis of patients.The HR of each prognostic factor were different in early-stage patients with ENKTCL.There are individual differences for each patient with regard to the predicted local failure rate,progression rate,mortality.ConclusionsStage Ⅰ/Ⅱ ENKTCL patients treated with CMT had significantly better LRC,PFS and OS than those treated with RT alone.Furthermore,RT followed by CT group resulted in the better LRC,PFS and OS than CT followed by RT in patients with stage Ⅰ/Ⅱ ENKTCL.The utilization of the quantitative evaluation on 5-year predicted local failure rate,progression rate and mortality based on the clinical features of each individual can help the decision making and individualize the optimal treatment modality for each patient. |
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