| Objective: To retrospectively analyze the clinical features and prognostic factors of patients with extranodal NK/T-cell lymphoma(ENKTL).To explore the expression levels of PD-L1 and IDO in patients with ENKTL,and to analyze the relationship between PD-L1 and IDO and clinical pathological features and prognosis.The aim of the present study was twofold.First,to retrospectively analyze the clinical features in patients with extranodal NK/T-cell lymphoma(ENKTL),and to research factors which affect the prognostic of ENKTL.Then,we aim to explore the expression levels of PD-L1 and IDO in patients with ENKTL,and to illuminate the relationship between PD-L1 and IDO expression level and the clinical pathological features and prognosis of ENKTL patients.Methods: 135 cases were enrolled from Hunan Cancer Hospital between February 2004 to November 2016,37 cases were enrolled from Xiangya Hospital of Central South University between May 2010 and May 2014,and 58 patients were enrolled from the Second Xiangya Hospital of Central South University between February 2011 and November 2011.All patients had initial un-treated ENKTL and with detectable cancerous tissues.Patients were diagnosed as NK/T-cell lymphoma according to WHO classification in 2016.The study was approved by local institutional review boards,and written informed consents were obtained from all patients before they contribute the cancerous tissues.A total of 230 patients were enrolled in this study.And the immunohistochemical staining(IHC)method was used to detect the expression level of PD-L1 and IDO,and the positive results were interpreted.The relationship between the expression levels of PD-L1 and IDO and the patients' clinical and prognosis data was analyzed.Results: The age of these 230 patients was range from 13 to 82 years old,with a median age of 44 years old,among which 163 were males and 67 were females,with a male to female ratio of 2.5:1.The primary tumor site of 218 patients was the upper aerodigestive tract and the 12 patients were non-upper aerodigestive tract.Of the 230 patients,only 48 of them were taken chemotherapy,34 cases were taken radiotherapy alone,128 cases were taken combined therapy.The 3-year overall survival(OS)rate was 58.8%,the median OS was 54.5 months,the 3-year PFS rate was 52.8%,and the median PFS was 45.4 months.Of the 230 patients,143 cases were positive for PD-L1 and 134 cases were positive for IDO.The results of Univariate analysis showed that lymphocyte count,PS score,elevated ?2-microglobulin level,PD-L1 high-expression and IDO high-expression were significantly correlated with PFS and OS.Multivariate analysis showed that elevated ?2-microglobulin level(P=0.001),decreased lymphocyte count(P=0.031)and high PD-L1 expression level(P=0.038)were independent associated with PFS,high ?2 microglobulin level(P=0.001)and IDO high-expression(P=0.005)were related to OS.All of These patients were divided into three groups according to their therapeutic regimens: radiotherapy alone,chemotherapy alone,and combined therapy.Hierarchical analysis results are shown that the long-term survival rate was comparative between the radiotherapy group and the combined therapy group,however,the chemotherapy group has the worst long-term survival rate(P=0.004).The 5-year PFS rates of the PD-L1 low-expression group and the high-expression group were 60.1% and 38.5%(P<0.001),and the 5-year OS rates were 63.5% and 40.2%(P < 0.001),respectively.The 5-year PFS rates of the IDO low-expression group and the high-expression group were 60.0% and 36.6%(P=0.001),and the 5-year OS rates were 61.9% and 37.1%(P=0.001),respectively.Conclusion: 1.The level of ?2 microglobulin,lymphocyte count and PD-L1 high-expression were independent poor prognostic factors for PFS,?2 microglobulin level and IDO high-expression were independent poor prognostic factors for OS.2.In ENKTL,PD-L1 and IDO have a high level expression,and patients with the characteristics have a poor prognosis.3.The expression of IDO was associated with LDH level. |
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