Objective: This study aimed to explore the clinical characteristics, survival rate, and prognostic factors of advanced-stage extranodal nasal type NK/T cell lymphoma (ENKTL) patients. Methods: The clinical data of 51 advanced-stage ENKTL patients in Peking Union Medical College Hospital from January 2012 to September 2019 were retrospectively analyzed. The clinical characteristics, treatment responses, survival rate, and prognostic factors were elucidated. The differences between nasal and non-nasal type and the significance of EBV-DNA in treatment response assessment and prognosis analysis were also evaluated. Results: The male-to-female ratio in the whole group was 2.9∶1 with a median age of 42 years old (range, 14-67 years) . The median follow-up time was 30 months (range, 1-78 months) . The one- and three-year progression-free survival (PFS) rates for the whole cohort were 34.1% and 24.6%, respectively, and the one- and three-year overall survival (OS) rates were 39.9% and 26.6%, respectively. The ratio of nasal to non-nasal type was 1.6∶1. The proportion of hemophagocytic lymphohistiocytosis (HLH) was significantly higher in non-nasal-type patients than nasal-type (P=0.039) , and the complete response (CR) rate of first-line chemotherapy is significantly lower in non-nasal type patients (P=0.008) . The median OS for nasal and non-nasal types were nine months and four months, respectively. The three-year PFS rates of nasal and non-nasal type patients were 36.0% and 10.0% (P=0.029) , respectively, and the three-year OS rates were 37.9% and 11.4% (P=0.050) , respectively. The correlation between the Epstein-Barr virus DNA (EBV-DNA) and treatment response were satisfactory. Survival curve between baseline EBV-DNA-negative and EBV-DNA-positive patients showed no significant difference. The three-year OS rates of EBV-DNA-negative and EBV-DNA-positive patients after one cycle of treatment were 77.9% and 8.1% (P=0.002) , respectively. In a multivariate analysis, EBV-DNA-positive following one cycle of treatment was an independent adverse prognostic factor for OS. Conclusions: The efficacy of pegaspargase-based chemotherapy and long-term survival of advanced-stage ENKTL patients were still poor. Clinical characteristics, treatment response, and long-term survival of non-nasal-type patients were worse than that of nasal-type patients. In a multivariate analysis, EBV-DNA-positive after one cycle of treatment was an independent adverse prognostic factor for OS. It can be used for early prediction of treatment response and prognosis.
目的： 探讨非局限期结外鼻型NK/T细胞淋巴瘤（ENKTL）患者的临床特征及预后影响因素。 方法： 回顾性分析北京协和医院2012年1月至2019年12月收治的51例Ⅲ~Ⅳ期ENKTL患者的临床资料。分析其临床特征、疗效、生存情况及预后影响因素，依据起病时是否存在鼻咽部受累分为鼻型与非鼻型，对比分析二者的差异，探讨EB病毒DNA（EBV-DNA）在疗效监测及预后评价中的意义。 结果： 所有患者的中位发病年龄为42（14~67）岁，男女比例为2.9∶1。中位随访时间为30（1~78）个月，非局限期患者中位总生存（OS）时间为7个月，1年及3年无进展生存（PFS）率分别为34.1%和24.6%，1年及3年OS率分别为39.9%和26.6%。鼻型与非鼻型患者的比例为1.6∶1。非鼻型患者合并噬血细胞综合征的比例较鼻型患者高（65.0%对35.5%，P=0.039），非鼻型患者一线化疗的完全缓解（CR）率较鼻型患者低（10.0%对45.2%，P=0.008）。非局限期鼻型与非鼻型患者的中位OS时间分别为9个月和4个月，3年PFS率分别为36.0%和10.0%（P=0.029），3年OS率分别为37.9%和11.4%（P=0.050）。EBV-DNA的变化趋势与疗效有良好的相关性。基线EBV-DNA阴性与阳性患者生存曲线的差异无统计学意义。1个疗程化疗后EBV-DNA阴性与阳性患者的3年OS率分别为77.9%和8.1%，差异有统计学意义（P=0.002）。多因素分析结果显示，1个疗程化疗后EBV-DNA阳性为OS不良的独立预后因素。 结论： 应用以培门冬酶为基础化疗方案的非局限期ENKTL患者的治疗有效率及远期生存仍较差。非鼻型患者在临床特征、化疗疗效及远期预后方面均较鼻型患者差。1个疗程化疗后EBV-DNA阳性为OS不良的独立预后因素，可用于早期预测疗效及预后。.
Keywords: Epstein-Barr virus DNA; Extranodal NK/T-cell lymphoma; Overall survival; Prognostic factor.