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目的:探讨结外鼻型NK/T细胞淋巴瘤的临床诊疗特征及其影响因素,为临床个体化治疗提供依据和经验。方法:回顾性分析2009-12-2016-07期间收治的25例结外鼻型NK/T细胞淋巴瘤患者的临床资料,包括临床表现、血清EBV-DNA检测、影像学检查、Ann-Arbor分期、病理、治疗方法及预后等。所有患者均由病理确诊并进行标准、规范及系统的治疗。采用Kaplan-Meier法和Log-rank检验进行单因素生存分析,Cox模型进行多因素分析并对影响预后的临床因素进行危险性评估。结果:25例患者中ⅠE+ⅡE期15例(60%),1年、3年总生存率(OS)分别为100%、100%;ⅢE+ⅣE期10例(40%),1年、3年OS分别为40.0%、26.7%,两者间OS差异有统计学意义(P=0.000)。采用单独放疗3例,1年、3年OS分别为100%、100%;单独化疗6例,1年、3年OS分别为53.6%、35.7%;放疗联合化疗综合治疗模式16例,1年、3年OS分别为84.6%、84.6%。3种治疗模式之间OS差异有统计学意义(P=0.027),且单独化疗者预后最差。进一步的多因素Cox回归模型结果显示,病程、B症状、EBV-DNA拷贝数阳性、治疗模式与该患者的预后转归关系密切(P=0.006、0.003、0.010、0.040)。结论:结外鼻型NK/T细胞淋巴瘤侵袭性强,总体预后较差。Ann-Arbor分期、治疗模式、病程、B组症状、EBV-DNA拷贝数阳性与结外鼻型NK/T细胞淋巴瘤的预后有密切关系。对早期局限于鼻腔的患者可单独放疗,疗效较好;对侵袭范围较大或晚期患者宜首选放疗加化疗为主的联合治疗模式。
Objective: To explore the clinical diagnosis and treatment of extranodal nasal type NK / T cell lymphoma and its influencing factors, and to provide basis and experience for clinical individualized treatment. Methods: The clinical data of 25 patients with extranodal nasal type NK / T-cell lymphoma who were treated during 2009-12-2016-07 were retrospectively analyzed. The clinical manifestations, serum EBV-DNA, imaging, Ann-Arbor staging , Pathology, treatment and prognosis. All patients were diagnosed by pathology and treated with standard, standardized and systematic methods. One-way survival analysis was performed by Kaplan-Meier method and Log-rank test. Cox model was used for multivariate analysis and risk factors for clinical factors influencing prognosis. Results: The overall survival rates of one year and three years were 100% and 100% in 15 patients (60%) in ⅠE + ⅡE and 25% The 3-year OS was 40.0% and 26.7%, respectively. There was a statistically significant difference in OS between the two groups (P = 0.000). 3 cases were treated with radiotherapy alone, and the 1-year and 3-year OS were 100% and 100% respectively. Six cases were treated with chemotherapy alone. The 1-year and 3-year OS were 53.6% and 35.7% respectively. , 3-year OS was 84.6% and 84.6% respectively. The differences in OS between the three treatment modalities were statistically significant (P = 0.027), and chemotherapy alone had the worst prognosis. Further multivariate Cox regression model results showed that course of disease, B symptoms, EBV-DNA copy number positive, the treatment model and the prognosis of the prognosis of this close (P = 0.006,0.003,0.010,0.040). Conclusion: Extranodal nasal NK / T cell lymphoma is aggressive and the overall prognosis is poor. Ann-Arbor staging, treatment modalities, course of disease, symptoms of group B, EBV-DNA copy number positive were closely related to the prognosis of extranodal nasal type NK / T cell lymphoma. On the early confined to the nasal cavity patients with radiotherapy alone, better effect; for the larger the scope of the invasion or advanced patients should preferred radiotherapy and chemotherapy-based combination therapy.