[Prognostic analysis of patients with nasal-type NK/T-cell non-Hodgkin's lymphoma--a report of 93 cases].
OBJECTIVE
Nasal-type NK/T-cell non-Hodgkin's lymphoma (NHL) is a unique subtype with the manifestation of local necrosis, infection and fever. The efficacy of chemotherapy alone is unsatisfactory; while radiochemotherapy plays some roles in the management of NK/T-cell lymphoma (NK/TCL). This study was to summarize the clinical characteristics, treatment outcome and prognosis of NK/TCL patients.


METHODS
Records of 93 patients with NK/TCL from Jan. 1997 to Jun. 2004 were analyzed retrospectively. All the patients were classified according to WHO classification system.


RESULTS
Of the 93 patients, 75 (80.6%) were in stage I-II, and 18 (19.4%) were in stage III-IV. The most common symptoms were nasal obstruction, rhinorrhea, and epistaxis. The disease course was 1-24 months with a median of 6.5 months. Of the 93 patients, 15 (16.1%) presented perforation of hard palate and/or nasal septum, 35 (37.6%) presented B symptoms; 35 (37.6%) were treated with chemotherapy alone, 2 (2.2%) were treated with radiotherapy alone, 54 (58.0%) were treated with radiochemotherapy, and 2 (2.2%) received no treatment. The first-line chemotherapy regimens were mainly CHOP and EPOCH. The overall response rate (RR) was 84.4% (76/90) with complete remission (CR) rate of 64.4% (58/90). The response rate of chemotherapy alone group was 67.6% (23/34) with CR rate of 41.2% (14/34). The response rate of combined modality group was 94.4% (51/54) with CR rate of 83.3% (45/54). The 2 patients who received no treatment died within 6 months. The major toxicity of chemotherapy was myelosuppression. The prevalence of grade III-IV neutropenia, thrombocytopenia, and anemia were 37.7%, 13.7%, and 10.7%. The major toxicities of radiotherapy were grade I-II mucosa lesion and myelosuppression. Other toxicities were mild. The mortality was 66.7% (62/93). The 1-, 3-, and 5-year overall survival (OS) rates were 63.4%, 43.1%, and 17.6%, respectively. Multivariate analysis showed that perforation of hard palate and/or nasal septum, B symptoms and therapeutic modality were independent prognostic factors of NK/TCL (P=0.035, P<0.001, and P=0.004).


CONCLUSIONS
NK/TCL has low chemotherapy sensitivity. Although combined chemoradiotherapy yield better outcome, the long-term survival was still poor. Investigation of optional treatment is needed.
Pan
Zhan-He
ZH
State Key Laboratory of Oncology in Southern China, Guangzhou, Guangdong 510060, P. R. China.
Huang
Hui-Qiang
HQ
Lin
Xu-Bin
XB
Xia
Yun-Fei
YF
Xia
Zhong-Jun
ZJ
Peng
Yu-Long
YL
Cai
Qing-Qing
QQ
Lin
Tong-Yu
TY
Jiang
Wen-Qi
WQ
Guan
Zhong-Zhen
ZZ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000139:chemically induced; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007694:Killer Cells, Natural / Q000473:pathology*; D016399:Lymphoma, T-Cell / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009503:Neutropenia / Q000139:chemically induced; D009669:Nose Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone