Clinicopathological Features And Prognosis Of Extranodal NK/T Cell Lymphoma

Background and objectExtranodal NK/T cell lymphoma is a rare non-hodgkin lymphoma subtype,which occurs mainly in the nasal cavity and upper respiratory tract.It is a special type,immunophenotype and biological behavior of malignant tumors.Extranodal NK/T-cell lymphomas are highly invasive and have a poor prognosis,often resulting in resistance to chemotherapy.Recent studies have shown an increase in the incidence rate and the proportion of young people.Extranodal NK/T-cell lymphoma has extensive clinical manifestations and tumor cell morphology.The early clinical manifestations and imaging are non-specific and can be misdiagnosed at the time of initial diagnosis.Therefore,the early correct diagnosis and prompt treatment of extranodal nasal type NK/T cell lymphoma have important significance for the survival assessment of patients.In this article,we retrospectively analyzed the clinical and pathological features of extranodal NK/T-cell lymphoma patients collected from the collected cases,analyzed the prognostic factors,and further accumulated information on the clinicopathological study and diagnosis and treatment of this disease.Methods1.Clinical and pathological study of 129 patients with extranodal NK/T cell lymphoma diagnosed by routine HE,immunohistochemistry,and EBER in situ hybridization,collected from Department of Pathology of First Affiliated Hospital of Zhengzhou University from January 2012 to December 2014 data.2.After finishing the relevant data,SSPS17.0 statistical software was used for data processing and analysis.The Kaplan-Meier method was used for univariate survival analysis.Log-rank test was used to compare the survival rate between groups,and the multi-factor prognosis of overall survival was analyzed.The analysis uses a COX regression model.When p<0.05,the difference was statistically significant.Results1.Among the 129 patients with extranodal NK/T cell lymphoma,85(65.9%)were male and 44(34.1%)were female.The male to female ratio was 1.9:1,and the age ranged from 13 to 76 years old.The median age was 45 years.2.In 87.6%of the patients,the primary site of tumors was upper aerodigestive tract,66%were primary nasal cavity,48.0%of patients had B symptoms,and mostly fever.25.6%of patients had local skin skeletal infiltration.3.Ann Arbor’s stage I patients accounted for 46.5%,phase II accounted for31.7%,and stage III and IV each accounted for 10.8%.IPI score of 0-1 points accounted for 53.5%,IPI score of 2-5 points accounted for 46.5%.Before treatment,79.8%of patients had WBC less than 4×10~9g/L,and hemoglobin less than 120g/L accounted for 39.5%before treatment.Patients with elevated serum LDH andβ2microglobulin accounted for 31.7%and 37.9%,respectively.4.In this group,43.6%of patients received chemotherapy alone,51.6%of patients received a combination of radiotherapy and chemotherapy,and only 4.8%of patients received radiotherapy alone.74.4%of patients had PR or CR after first-episode treatment,and the overall response rate(ORR)was 76.3%after first-episode treatment.Chemotherapy mostly uses non-anthracycline-based combination chemotherapy regimens.5.85 cases of primary nasal cavity in this group were diagnosed with CT,MRI,or PET-CT at the time of initial diagnosis.CT and MRI imaging showed 28 cases of nasal cavity lesions,5 cases considered nasal malignant tumors,such as nasopharyngeal carcinoma,4 cases were considered Lymphoma,22 cases of chronic inflammation,16 cases considered nasal polyps,1 case of nasal bone fractures.The PET-CT report suggested that 2 cases were consistent with lymphoma.Based on the above imaging findings,the detection rate of nasal lesions in 85 patients was 45.8%(39/85).6.Microscopically,there were 102 cases(79.0%)and 58 cases(44.9%)of necrosis and vascular invasion.There were 54 cases(41.8%)of tumor cell size in small cell morphology,and 75 cases of medium-large cell form.(58.2%),immunohistochemical Granzyme-B,TIA-1 were both positive in 112 cases,accounting for 86.8%,Ki-67≥70%in 72 cases,accounting for 55.8%.7.The study was completed until the last follow-up time on December 31,2017.The follow-up period was from January to July.There were 30 patients who died eventually,59 survived,and 40 were lost.Kaplan-Meier single factor survival analysis showed that the age of≥60 years,pre-treatment Hb<120g/L,tumor on the upper respiratory alimentary,local skin bone infiltration,with B symptoms,IPI score≥2 points,serum LDH The increase ofβ2-MG andβ2-MG were the unfavorable factors of prognosis(p<0.05),but gender and pretreatment WBC<4×10~9/L had no significant difference in overall survival(p>0.05).The combination of chemotherapy or radiochemotherapy combined with first-episode curative effect to obtain CR or PR is a favorable prognostic factor(p<0.05).The results of multivariate analysis using COX regression model showed that the age of onset,local skin skeletal infiltration,IPI score,B symptoms,and serum LDH levels were independent prognostic risk factors(p<0.05).Conclusion1.The final diagnosis of extranodal NK/T cell lymphoma depends on histopathological morphology,immunohistochemistry,and EBER in situ hybridization.2.Age of onset≥60 years,local skin skeletal infiltration,IPI score≥2 points,accompanying B symptoms,and elevated serum LDH were independent prognostic risk factors for extranodal NK/T-cell lymphoma.3.The combination of radiotherapy and chemotherapy for extranodal NK/T cell lymphoma patients can improve survival benefits compared with monotherapy.