The Analysis Of The Therapeutic Effects And Prognostic Factors Of 52 Patients With Early-stage Nasal NK/T Cell Lymphoma

Objective:Through the retrospective analysis of clinical data and the treatment results of 52 patients pathologically proved early-stage ENKTL to discuss the therapeutic effects and prognostic factors to provide the evidence for the standard treatment of ENKTL.Methods:Retrospective analysis of clinical data of 52 cases with early-stage ENKTL from March 2007 to March 2014 in our radiation department,including age,sex,Ann Arbor stage,stage IE with super cavity,LDH,mIPI,PS,B symptoms,local invasion number.According to the revision of the 2002 AJCC / UICC TNM Ann Arbor staging criteria and Chinese Academy of Medical Sciences Cancer Hospital stage principles:25 cases of stage IE,including 14 cases of limited stage,11 cases of super cavity,27 cases of stage IIE;LDH elevated in 36 cases,normal in 16 cases;mIPI < 2 in 24 cases,≥2 in 28cases;PS< 2 in 31 cases,≥2 in 21 cases;B symptoms in 24 cases,28 cases without B symptoms.Local invasion number < 2 in 25 cases,≥2 in 27 cases.Stage IE 15 cases and stage IIE 10 cases of all patients received radiotherapy alone;stage IE 10 cases and stage IIE 17 cases received combined treatment including chemotherapy after radiotherapy and radiotherapy after chemotherapy.Radiotherapy group were using linear accelerator 6MV X-ray to beam primary nasal tumor and neck metastasis lymph node(GTVnx/GTVnd)by Three-dimensional conformal or intensity-modulated radiotherapy ranging from 50.4 to 59.4Gy,involved field and neck lymph node drainage area with high risk(CTV)about 40~45Gy without prophylactic irradiation out of metastasis of cervical lymph drainage area through conventional fractionated irradiation about 1.8~2.0Gy/f,5 times per week.Same radiotherapy was used between combined group and radiotherapy alone group.Chemotherapy chose CHOP(cyclophosphamide,doxorubicin,vincristine,prednisone),21 days per cycle,4 cyclestotally.After treatment,the overall survival rate(OS)and local control rate(LCR)were observed,compared and prognosed to analyze the related significant factors of1,3,5y-OS and 1,3,5y-LCR between patients treated with radiotherapy alone and combined mode by U iatesurvival and Cox model multivariate analysis.Results:1.Short-term effects: 9 patients reached CR(9/25,36.0%),6 cases PR(6/25,24.00%),2 case SD(2/25,8%),8 cases PD(8/25.32.0%)with total efficiency of 60% of 25 patients with radiotherapy alone.15 patients reached CR(15/27,55.6%),7 cases PR(7/27,25.9%),4 cases SD(4/27,14.8%),1 case PD(1/27,3.7%)with total efficiency of 81.48% of 27 patients with combined treatment.The short term effects of the radiotherapy alone equaled to that of the combined treatment.2.Overall survival rate:1,3,5y-OS in all patients were 82.6%,71.2% and59.6%.1,3,5y-OS batween radiotherapy and combined treattment were 80.0% and85.2%(P=0.621),72.0% and 70.4%(P=0.897),56.0% and 63.0%(P=0.609).Add chemotherapy to radiotherapy can not significantly improve the overall survival.3.Local control probability:1,3,5y-LCR in all patients were 65.4%,38.5% and23.1%,1,3,5y-LCR were 64.0% and 66.7%(P=0.840),32.0% and 44.4%(P=0.357),20.0% and 25.9%(P=0.304),respectively.Add chemotherapy to radiotherapy can not significantly improve the local control probability.4.Univariate analysis(log rank test)showed significant difference in survival rate among age(P = 0.013)、stage(P = 0.005)、LDH(P = 0.011),mIPI(P = 0.015)、PS(P= 0.000)、local invasion number(P = 0.012)、rate of CR after the first course of treatment(P = 0.000)and combined mode(P = 0.034),but gender,stage IE with super cavity,B symptoms showed no significant difference in survival rates.The combined analysis including univariate and Cox regression multivariate analysis showed that PS,rate of CR after the first course of treatment were the independent risk factors in 5y-OS of early-stage ENKTL patients,because of each P values of which less than 0.05 with statistical signficance.The more PS score and not reaching to CR mean shorter OS rate and worse prognosis.Meanwhile,The combined analysis including univariate and Cox regression multivariate analysis showed that rate of CR after the first course of treatment was the independent risk factor in 5y-LCR of early-stage ENKTL patients.Reaching to CR mean higher LCR and better prognosis.Conclusions::1.Radiotherapy still was the optimal and main treatment method.for early-stage ENKTL patients.Adding chemotherapy to the optimal radiotherapy treatment did not significantly improve short-term effects,overall survival and local control rate.2.Age,Ann Arbor stage,LDH,mIPI,PS score,local invasion number,rate of CR were important factors for 5y-OS in patients with early-stage ENKTL,but PS and rate of CR were significant factors.Sex and rate of CR were important factors for 5y-LCR in patients with early-stage ENKTL,but only rate of CR were significant factors.