Clinical characteristics and survival analysis of extra-upper aerodigestive tract extranodal NK/T-cell lymphoma

doi:10.3760/cma.j.issn.1673-422X.2020.03.006

Abstract

Abstract:

Objective To analyze the clinical characteristics, survival outcome and prognostic factors of patients with extra-upper aerodigestive tract extranodal NK/T-cell lymphoma (EUADT-ENKTCL). Methods We collected the clinical data of 779 patients with ENKTCL who were registered in SEER (Surveillance, Epidemiology, and End Results) database from 2000 to 2015 including 622 cases diagnosed with upper-aerodigestive tract extranodal NK/T-cell lymphoma (UADT-ENKTCL) and 157 cases with EUADT-ENKTCL. Clinical characteristics, survival outcome and prognostic factors were analyzed in EUADT-ENKTCL patients. Results The median age of patients with EUADT-ENKTCL was 55. The ratio of male to female was 1.85∶1. Compared with UADT-ENKTCL, patients with EUADT-ENKTCL accounted a higher proportion of malignant T-cell origin (χ ²=18.916, P<0.001), advanced stage disease (χ ²=63.669, P<0.001), accompanied B symptoms (χ ²=14.657, P=0.001) and receiving chemotherapy alone (χ ²=71.412, P<0.001). EUADT-ENKTCL could be originated in different organs and tissues throughout the body, among which the skin or subcutaneous soft tissues was the most common locations (38.2%, 60/157), followed by gastrointestinal tract (18.5%, 29/157), lung/pleura (13.4%, 21/157), testis (6.4%, 10/157), orbit (5.1%, 8/157) and others. The median overall survival (OS) was 8.0 months and 5-year OS rate was 24.0% for the EUADT-ENKTCL cohort, which were much inferior to those of UADT-ENKTCL patients (31.0 months and 43.5%; χ ²=32.080, P<0.001). Univariate analysis showed that patients with advanced stage or primary lung disease of EUADT-ENKTCL had unfavorable OS. Stage was a prognostic factor of OS via multivariate analysis (Ⅲ/Ⅳ vs. Ⅰ/Ⅱ, HR=2.078, 95%CI: 1.335-3.234, P=0.001). Conclusion EUADT-ENKTCL is a highly aggressive malignancy. Compared with UADT-ENKTCL, EUADT-ENKTCL patients have different clinical characteristics and significantly inferior OS.

Key words: Lymphoma, extranodal NK-T-cell, Survival, Prognosis, Extra-upper aerodigestive tract

Qi Fei, Dong Mei. Clinical characteristics and survival analysis of extra-upper aerodigestive tract extranodal NK/T-cell lymphoma[J]. Journal of International Oncology, 2020, 47(3): 157-163.

Figures/Tables 6

References 28

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临床特征	UADT-ENKTCL 组(n=622)	EUADT-ENKTCL 组(n=157)
年龄(岁)
≤60	398(64.0)	90(57.3)	2.378	0.123
>60	224(36.0)	67(42.8)
性别
女	231(37.1)	55(35.0)	0.239	0.624
男	391(62.9)	102(65.0)
种族
白种人	436(70.1)	112(71.3)
黑种人	23(3.7)	6(3.8)	0.123	0.940
其他	163(26.2)	39(24.8)
细胞起源
NK细胞	459(73.8)	88(56.1)
T细胞	133(21.4)	57(36.3)	18.916	<0.001
其他	30(4.8)	12(7.6)
分期
Ⅰ~Ⅱ期	473(76.0)	72(45.9)
Ⅲ~Ⅳ期	126(20.3)	60(38.2)	63.669	<0.001
不详	23(3.7)	25(15.9)
B症状
无	304(48.9)	51(32.5)
有	240(38.6)	75(49.0)	14.657	0.001
不详	78(12.5)	31(17.8)
治疗模式
无	91(14.6)	40(25.5)
单纯化疗	143(23.0)	77(49.0)	71.412	<0.001
单纯放疗	107(17.2)	16(10.2)
放化疗联合	281(45.2)	24(15.3)

特征	单因素分析				多因素分析
特征	HR值	95%CI	P值		HR值	95%CI	P值
年龄(>60岁vs.≤60岁)	1.432	1.557~1.772	0.001	1.311		1.041~1.650	0.021
性别(男vs.女)	1.070	0.860~1.331	0.543	-		-	-
种族
白种人	1			1
黑种人	2.513	0.994~2.303	0.054	1.346		0.853~2.124	0.202
其他	0.981	0.776~1.267	0.944	0.923		0.721~1.182	0.527
细胞来源(T vs. NK细胞)	1.173	0.985~1.397	0.073	1.096		0.840~1.429	0.500
分期(Ⅲ~Ⅳ vs.Ⅰ~Ⅱ)	2.133	1.693~2.687	<0.001	1.839		1.048~3.228	0.034
B症状(有vs.无)	1.242	1.128~1.368	<0.001	1.115		0.872~1.426	0.386
原发部位(鼻腔外vs.鼻腔)	1.531	1.237~1.895	<0.001	1.427		1.122~1.815	0.004
治疗模式
无	1			1
单纯化疗	1.124	0.817~1.547	0.473	1.076		0.768~1.509	1.076
单纯放疗	0.705	0.493~0.956	0.047	0.838		0.572~1.227	0.363
放化疗联合	0.433	0.316~0.593	<0.001	0.514		0.347~0.719	<0.001

特征	HR值	95%CI	P值
年龄(>60岁vs.≤60岁)	1.274	0.900~1.803	0.172
性别(男vs.女)	0.828	0.578~1.187	0.305
种族
白色	1
黑色	0.987	0.362~2.691	0.980
其他	0.914	0.595~1.404	0.682
细胞来源(T vs. NK细胞)	1.012	0.701~1.460	0.957
分期(Ⅲ~Ⅳ vs.Ⅰ~Ⅱ)	1.855	1.259~2.735	0.001
B症状(有 vs.无)	1.274	0.834~1.947	0.263
原发部位
皮肤	1
肺	1.692	1.014~2.823	0.044
胃肠道	0.976	0.588~1.620	0.924
睾丸	1.049	0.496~2.218	0.900
眼眶	0.935	0.401~2.181	0.876
治疗模式
无	1
单纯化疗	0.848	0.555~1.298	0.449
单纯放疗	0.824	0.440~1.534	0.545
放化疗联合	0.578	0.325~1.027	0.062