Impact Of Patient Age On Treatment Choice And Survival Outcome In Extranodal Nasal-type NK/T-cell Lymphoma

Part ?:Impact of patient age on treatment choice and survival outcome in extranodal nasal-type NK/T-cell lymphomaObjective Age above 60 is an adverse factor for aggressive lymphoma,however,the majority of patients with extranodal nasal-type NK/T-cell lymphoma(NKTCL)were younger than 60 years.The effect of patient age as a continuous variable on treatment choice and survival outcome in NKTCL is rarely studied.Materials and methods Between January 2000 and June 2015,2640 patients with NKTCL from 16 institutions in China were retrospectively reviewed.Clinical characteristics and treatment strategies were compared according to patients5 age stratatification(? 21 vs.22-44 vs.45-60 vs.>60).Multivariable proportional hazards modeling using penalized spline regression was used to examine the association between age and overall survival(OS),and to determine whether there was an age cutoff point denoting OS difference.The relative performance of different treatment modalities was plotted with increasing age.Results The number of patients in age group ? 21,22-44,45-60 and>60 was 206,1205,868 and 361,respectively.For all patients,there was no obvious trend towards increasing age in clinical characteristics except for more adverse factors in age group ? 21(B symptoms,elevated LDH,primary tumor invasion(PTI)and Stage ?/? diseases:51.9%,42.2%,59.2%and 19.0%for age<21 vs.30.2%-42.9%,29.1%-33.4%,53.5%-57.7%and 11.1%-11.7%for age>22).Treatment varied markedly with age;older patients were more likely to receive radiotherapy alone(24.7%in age>60 vs.10.2%in age<21).After a median follow up time of 41.9 months,the 5-year OS for age group<60 and>60 were 62.5%and 54.8%(P<0.001).After adjustment for gender,ECOG,stage,LDH,PTI,primary site and B symptoms,increasing age was associated with increased mortality in a time-dependent manner,without an apparent cutoff point.With regard to OS,the relative performance of RT based therapy compared with CT alone improved with increasing age for stage ?/? patients(HR for the whole group:0.347,95%CI:0.287-0.420,P<0.001).The improved survival was also found when comparing new regimen to old regimen for patients receiving chemotherapy(HR for the whole group:0.708,95%CI:0.588-0.852,P<0.001).For stage III/IV patients,new regimen significantly prolonged OS compared with old regimen(HR for whole group:0.678,95%CI:0.463-0.992,P = 0.044).Conclusions Older patients are more likely to receive radiotherapy alone.Patient age is significantly associated with survival outcome,without an apparent age cutoff point showing survival differences.RT could significantly improve overall survival compared with CT alone in stage I/II patients,independent of age.Similar result was found for new chemotherapy regimen in all stage groups.Part ?:Clinical differences between nasopharyngeal NK/T-cell lymphoma and nasal NK/T-cell lymphoma with nasopharynx extensionObjective The study aimed to clarify the clinical and prognostic difference between primary nasopharyngeal natural killer(NK)/T-cell lymphoma(NP NKTCL)and NK/T-cell lymphoma of the nasal cavity with nasopharynx extension(N-NP NKTCL).Materials and methods Eighty-nine patients with NP NKTCL and 113 patients with N-NP NKTCL were retrospectively analyzed.Clinical features,treatment responses and prognosis were compared between the two groups.Results NP NKTCL patients showed similar clinical features compared with N-NP NKTCL except for a relative low rate of elevated LDH in NP NKTCL group.Two group patients presented with high cervical nodal involvement(55.1%vs.42.5%).The complete response(CR)rate after initial chemotherapy in NP NKTCL group was significant higher than N-NP NKTCL group(43.8%vs.19.6%,P = 0.006),while the CR rate after primary radiotherapy was similar between the two groups(63.4%vs.62.7%,P=0.629).The 5-year OS and PFS rates were similar in the two groups and even for early stage patients.In patients with early-stage NP NKTCL,radiotherapy with or without chemotherapy resulted in similar survivals compared with chemotherapy alone(5-year OS:70.5%vs.33.3%,P=0.238;5-year PFS:56.7%vs.33.3%,P= 0.431).Similar results was found in N-NP NKTCL group,the 5-year OS for radiotherapy with or without chemotherapy and chemotherapy alone were 57.4%and 33.3%(P = 0.246),respectively;the 5-year PFS were 49.3%and 16.7%(P = 0.177),respectively.In addition,the failure patterns in the two groups showed distant extra-nodal dissemination and followed by lymph node relapse.Conclusions Patients with N-NP NKTCL and NP NKTCL showed similar clinical features and prognoses,but different initial response to chemotherapy.Part ?:Treatment trends and prognosis of breast ductal carcinoma in situ(DCIS)-single center analysisObjective To analyze the clinical characteristics,treatment outcome and prognostic factors of ductal carcinoma in situ(DCIS).Materials and Methods 617 patients treated in our institution between 2000 and 2013 were retrospectively reviewed.Kaplan-Meier was used to calculate the local control(LC),disease free survival(DFS)and overall survival(OS).Log-rank test was used to testify the prognostic factors.Results The number of DCIS and the proportion of breast conservative surgery grew with time.Mastectomy was the main surgery method.Of them,the number of patients received mastectomy,breast conservative surgery plus radiotherapy and breast conservative surgery alone were 374,160 and 83,respectively.366 patients(83.6%)with positive hormone receptor received hormone therapy and 45 patients(7.3%)underwent chemotherapy.With a median follow up time of 47 months,the 5-year LC,DFS and OS were 98.4%,97.5%and 98.9%,respectively.Univariate analysis showed that Her2 positive patients had worse OS.Although mastectomy group had more adverse factors compared with breast conservative surgery with or without radiotherapy group,two treatment groups had similar survival results.Mastectomy had better LC and DFS compared with breast conservative surgery alone.Conclusions Patients with ductal carcinoma in situ(DCIS)have favorable prognosis regardless of the treatment strategies.Mastectomy can reduce ipsilateral breast tumor recurrence rates.