| Background and Purpose: Extranodal NK/T-cell lymphoma(ENKTL)is a rare subtype of non-Hodgkin's lymphoma.The incidence rate is about 6% of all malignant lymphomas.There are obvious geographical differences,and China and Southeast Asian countries are more frequent,while Europe and North America are rare.The primary sites of ENKTL are commonly found in the nose,nasopharyngeal,oropharynx,and Wecht's rings.A few of them can invade extranodal tissues such as the skin,gastrointestinal tract,testis,and bone marrow.The clinical manifestations are mostly nasal congestion,nasal bleeding,hoarseness,nasopharyngeal Department of tumors,etc.,can destroy the bottom of the nasal cavity to form a characteristic hard palate perforation,accompanied by odor.ENKTL is a highly aggressive malignant tumor with rapid progression and easy recurrence and metastasis.There is no standard treatment plan and poor prognosis.The body mass index(BMI)is considered to be closely related to the prognosis of the tumor.It has been reported in breast,kidney,gallbladder,and esophageal cancer that BMI is related to its prognosis.Studies have shown that high BMI is positively correlated with overall survival in some non-Hodgkin's lymphomas.However,there are few reports about the correlation between BMI and ENKTL prognosis at home and abroad.In this study,61 patients with advanced untreated ENKTL diagnosed at the FirstAffiliated Hospital of Zhengzhou University were recruited.The patient's age,gender,ECOG score,LDH level,B symptoms,?2-MG,serum EBV-DNA,IPI score,PINK score,treatment status,and specific survival time were collected.We retrospectively analyzed the relationship between pretreatment BMI and common clinical pathological factors of advanced ENKTL,studied the effect of pretreatment BMI on the short-term efficacy and long-term efficacy of ENKTL,and explored the influencing factors affecting the prognosis of advanced ENKTL.Materials and Methods: 1.Retrospective analysis of the 61 newly diagnosed stage III-IV ENKTL patients in the First Affiliated Hospital of Zhengzhou University.Among them,there are 35 males and 26 females,aged between 14-64 years,with a median age of 39 years.According to the modified Ann Arbor stage,there were 23 patients with stage III and 38 patients with stage IV;31 cases with normal LDH and 30 cases with elevated LDH;22 cases without B symptoms and 39 cases with B symptoms;36 cases with EBV-DNA negative,25 cases with EBV-DNA positive;42 cases with ?2-MG negative,19 cases with ?2-MG positive;48 cases with ECOG 0-1 score,13 cases with ECOG ?2 score;24 cases with IPI 0-2 score,37 cases with IPI?3 score;28 cases with PINK 0-1 score,33 cases with PINK?2 score.2.Pre-treatment BMI was calculated for all patients.The patients were divided into low BMI group and high BMI group.The ?2 test was used to compare the correlation between BMI and ENKTL common clinical factors and short-term efficacy;the Kaplan-Meiri method was used to draw survival curves to compare the correlation between BMI and other factors and the long-term efficacy of ENKTL,Comparison of survival rates between groups using the log-rank test.Inclusion of meaningful results into a COX regression model for multivariate analysis to study the effect of BMI and other clinical factors on the prognosis of advanced ENKTL patients.Results: 1.BMI grouping in ENKTL: With BMI=20.0 as the cutoff value,42 patients (68.9%)were classified as high BMI group,and 19 patients(31.1%)were classified as low BMI group.2.The correlation between BMI and common clinical factors of ENKTL: Among the 19 patients with low BMI,7 patients with ECOG?2(36.8%,7/19),and 42 patients with high BMI had 6 patients with ECOG?2(14.29%,6/42).The difference was statistically significant(?2=3.969,P=0.046);13 cases(68.42%,13/19)with elevated LDH levels in 19 patients with low BMI,and 17 cases with elevated LDH levels in 42 cases with high BMI(40.48%,17/42),The difference was statistically significant(?2=4.087,P=0.043).There was no significant correlation between BMI subgroups in age,sex,B symptoms,?2-MG,staging,serum EBV-DNA,IPI,PINK and other factors(P>0.05).3.The correlation between BMI and short-term efficacy in ENKTL: Among the 19 patients with ENKTL in the low-BMI group,13 patients achieved CR,with a CR rate of 68.42%;16 patients with CR+PR and ORR of 84.21%.Among the 42 patients with ENKTL in the high BMI group,39 patients achieved CR with a CR rate of 92.86%;41 patients with CR+PR had an ORR of 97.62%.There was no significant difference in CR rate and ORR between the two groups(P>0.05).4.The correlation between BMI and long-term efficacy in ENKTL: In the low BMI group,1 year PFS was 72.02%;2 years PFS was 48.01%;3 years PFS was 48.01%;In the high-BMI group,1 year PFS was 92.32%;2 years PFS was 89.24%;3 years PFS was 80.32%.The PFS was statistically significant in the high BMI and low BMI groups(Log-rank P=0.0012).In the low BMI group,the 1-year OS was 82.59%;the 2-year OS was 55.62%;the 3-year OS was 44.49%;the high BMI group had 1 year OS of 95.05%;the 2-year OS was 92.55%;the 3-year OS was 83.50%.There was a statistically significant difference in OS between the high BMI group and the low BMI group(Log-rank P=0.0010).5.Univariate analysis showed that the factors associated with poor prognosis were: BMI <20,ECOG ?2,?2-MG positive,stage IV,PINK ?2,and the difference was statistically significant(P<0.05).Combining factors related to prognosis with univariate analysis into the COX proportional hazards model for multivariate analysis,the results showed that ECOG,?2-MG,and BMI may be independent risk factors for the prognosis of patients with stage III-IV ENKTL(P<0.05).Conclusion: In the advanced and initial treated ENKTL patients,the DDGP regimen has a good effect,and the long-term efficacy of high BMI patients is significantly better than that of low BMI patients.BMI,ECOG,and ?2-MG may be independent prognostic factors affecting the prognosis of advanced ENKTL patients. |
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