| Objective:Extranodal NK/T-cell lymphoma,nasal type(ENKTL)is a rare type of non-Hodgkin's lymphoma(NHL)originating from mature NK cells or NK-like T cells,it is more common in East Asia and China.ENKTL mainly occurs outside the lymph nodes,the majority of ENKTL originated in the nasal cavity,sinuses,Waldeyer's ring,oral cavity,larynx,hypopharynx,even the mandible or cheek.It is characterized by high malignancy,strong invasion,poor prognosis and easy recurrence.It is often accompanied by hemophagocytic syndrome.At present,many researches have shown that ENKTL is closely related to Epstein Barr Virus(EBV)infection.EBV infection may be related to the pathogenesis of ENKTL.EBV is a DNA virus of the human herpesvirus gamma subfamily lysophilus virus.Most people have been infected with EBV during childhood and can carry the virus for a lifetime after infection with EBV.the detection of EBV-DNA copy number in whole blood is relatively convenient.this study is to explore whether EBV-DNA copy number can be used as a clinical indicator for predicting the efficacy and prognosis of ENKTL by analyzing the correlation between EBV-DNA copy number and ENKTL related clinical and laboratory indicators,efficacy and prognosis.At present,there are few reports about anti-EBV treatment in the course of ENKTL radiotherapy and chemotherapy.In this study,anti-EBV treatment was added to EBV-positive patients on the basis of combined radiotherapy and chemotherapy.It was observed whether anti-EBV treatment could improve the efficacy and prognosis.Methods:The Whole blood EBV-DNA copy numbers of 68 ENKTL patients was measured by fluorescence quantitative PCR.According to the number of EBV-DNA copies,the patients were divided into EBV positive group(EBV-DNA?400copies/mL)and EBV negative group(EBV-DNA<400copies/mL).The differences in related clinical and laboratory indicators between the two groups were compared.EBV positive group had 38 patients and EBV negative group had 30 patients.EBV positive patients were divided into anti EBV treatment group of 10 cases(on the basis of radiotherapy and chemotherapy ganciclovir was added to anti EBV treatment)and non anti EBV treatment group of 28 cases(Simple radiotherapy and chemotherapy).The efficacy and prognosis between anti EBV treatment group and non anti EBV treatment group was compared.The efficacy and prognosis between 28patients with EBV positive(non anti EBV treatment)and 30 patients with EBV negative was compared.Results:1.The general clinical features of ENKTL patients:The proportion of male and female in 68 patients with ENKTL was 3:1.The average age is 43years old.63.2%patients Ann Arbor stage was early stage(stage I,stage II).37 patients had B symptoms.Prognostic index of natural killer cell lymphoma(PINK):67.6%patients were intermediate and high risk.ECOG physical status score:98.5%patients were grade 1 to 2.The median of white blood cell was 4.69×10~9/L,the median of lymphocyte count was 1.13×10~9/L,the median of hemoglobin was 126.00g/L,the median of platelet was 172×10~9/L.The median of erythrocyte sedimentation rate was 19.00mm/h.The average of albumin is 39.66g/L.The median of globulin is 25.75g/L.The median of Lactate dehydrogenase(LDH)is 197.00U/L.The median of?2-microglobulin(?2-MG)is 2.57mg/L.9 patients were immunohistochemical CD56-,40 patients were immunohistochemical Ki-67?60%.2.The infection rate of EBV in ENKTL patients:65 cases of ENKTL patients were found in originating from the nasal cavity and its surrounding tissues,the infection rate of EBV was 56.9%.3 cases of ENKTL patients were found in originating from the skin,the infection rate of EBV was 33.3%.3.The comparison between EBV positive group and EBV negative group ENKTL patients related clinical,laboratory indicators,efficacy and prognosis:47.4%patients of EBV positive group were Ann Arbor stage III to IV,23.3%patients of EBV negative group were Ann Arbor stage III to IV(P=0.041).78.9%patients of EBV positive group had intermediate or high risk of PINK,53.3%patients of EBV negative group had intermediate or high risk of PINK(P=0.025).The median of white blood cells in EBV positive and EBV negative groups were 4.55×10~9/L and 5.18×10~9/L(P=0.029);The median of lymphocyte in EBV positive and EBV negative groups were 0.80×10~9/L and1.23×10~9/L(P=0.003);The median of platelets in EBV positive and EBV negative groups were 158×10~9/L and 186×10~9/L(P=0.031).The median of LDH in the EBV positive group was 210.00U/L,the median of LDH in the EBV negative group was 179.50U/L(P=0.006).The Objective response rate(ORR)of the EBV positive group was 32.1%,the ORR of the EBV negative group was 66.7%(P=0.009).The median overall survival time of the patients in EBV positive and EBV negative groups was 25 months and 36 months(P=0.014).There was significant difference between the two groups in the above indicators.4.The comparison between efficacy and prognosis of anti EBV treatment group and non anti EBV treatment group:The ORR rate in the anti EBV treatment group and non anti EBV treatment group was 70%and 32.1%,there wasnostatisticallysignificantdifferencebetweenthetwo groups(P=0.062).The median overall survival time in anti EBV treatment group was 33 months and the median overall survival time in non anti EBV treatment group was 23 months,the difference between the two groups was statistically significant(P=0.028).Conclusion:1.The EBV positive group was compared with the EBV negative group,EBV positive patients with late Ann Arbor stage,high intermediate or high risk of PINK,low white blood cell,low lymphocyte count,low platelet,high LDH.2.The ORR rate of ENKTL patients with EBV positive group was low,and the median overall survival time was short.EBV infection can reduce the clinical efficacy of ENKTL patients,and is associated with poor prognosis.3.The median overall survival time in the anti EBV treatment group was longer than non anti EBV treatment group.Anti EBV treatment may improve the prognosis of ENKTL patients. |
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