ABSTRACT
Aim: The study is to analyze the clinicopathological features of extranodal NK/T cell lymphoma, nasal type (ENKCL) and its treatment and efficacy, to provide a scientific basis for individualized treatment.
Methods: We conducted a retrospective analysis of the clinicopathological records of 18 ENKCL cases treated in Union Hospital of Fujian Medical University from May 2007 to May 2012, with follow-up of patients and univariate and multivariate analysis of the clinicopathological parameters, treatment and 2-year survival rate.
Results: Among the 18 ENKCL cases, patients’ age ranged from 20 to 69, with an average age of 41.3 and male/female ratio of 7/1. The 2-year overall survival (OS) rate in Ann Arbor StageⅠ/Ⅱ patients with ECOG PS <2, over 2 sites of extranodal involvement, no bone marrow infiltration and international prognostic index (IPI) ≤2 was significantly higher than Ann Arbor Stage Ⅲ/Ⅳ patients with ECOG PS ≥2, less than 2 extranodal involvement sites, bone marrow infiltration and IPI >2. The 2-year OS rate of patients with white blood cell count (before treatment) ≥4.0×109/L, hemoglobin value ≥120g/L and normal lactate dehydrogenase level was significantly higher than patients with white blood cell count (before treatment) <4.0 ×109/L, hemoglobin <120 g/L and elevated lactate dehydrogenase level. Patients’ age, gender, B symptoms and albumin level in blood before treatment were not related to prognosis.
After receiving the first course of chemotherapy, radiotherapy or both, 11 out of the 18 patients achieved complete remission and 7 did not and the 2-year OS rate of the former was significantly higher than that of the latter. 15 patients received chemotherapy alone or chemotherapy and radiotherapy combined. The 2-year OS rate of those who were treated with first-line regimen as classic CHOP were significantly improved compared with those receiving other treatments. Among the 8 patients treated with only chemotherapy, 4 of them received 1-2 cycles of therapy and 4 went through over 2 cycles, and the 2-year OS rate of the two showed no statistically significant difference. Immunohistochemical results suggested that the 2-year OS rates in patients with NK cell phenotype, negative or low CD56 expression and Ki-67 proliferation index higher than 30% was significantly increased compared with those with T cell phenotype, medium or high CD56 expression and Ki-67 expression lower than 30%. Multivariate analysis indicated that tumor stage, ECOG PS score, the number of sites of extranodal involvement, bone marrow infiltration, IPI score, white blood cell count before treatment, hemoglobin value, lactate dehydrogenase level, efficacy of first treatment, CD56 and Ki-67 expression, and lymphocyte phenotype are independent prognostic factors for ENKCL.
Conclusion. ENKCL lesions develop rapidly with poor prognosis. Ann Arbor staging, ECOG PS score, the number of extranodal involvement sites, bone marrow infiltration, IPI score, white blood cell count before treatment, hemoglobin value, lactate dehydrogenase level, the efficacy of first treatment, CD56 and Ki-67 expression, and lymphocyte phenotype are independent prognostic factors, correlated with prognosis and survival and important for clinical diagnosis and treatment. Though today we promote the comprehensive treatment of ENKCL, chemotherapy is still of great importance. Individualized treatment needs to be further studied and prognostic indicators of greater clinicopathological significance for ENKCL are worthy of further exploration. >albumin level in blood before treatment were not related to prognosis.
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