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目的:比较含培门冬酶方案P-GEMOX与传统CHOP方案一线治疗结外NK/T淋巴瘤的近期疗效、远期生存及安全性,并探讨其预后影响因素。方法:回顾性分析我院2010~2015年45例结外NK/T淋巴瘤患者的临床资料,比较两种治疗方案之间的疗效,并进行预后因素分析。结果:28例早期结外NK/T淋巴瘤患者治疗以放化疗联合为主,ORR为85.7%(24/28),CR为82.1%,其中CHOP方案联合放疗组ORR为80.0%(12/15),CR为73.3%,2年OS率为73.3%,PFS率为66.7%。P-GEMOX方案联合放疗组ORR为92.3%(12/13),CR为92.3%,2年OS率为92.3%,PFS率为92.3%,两组的ORR,OS及PFS率差异无统计学意义(P>0.05)。17例晚期患者治疗以化疗为主,ORR 41.1%(7/17),CR为17.6%,其中CHOP方案治疗组ORR为12.5%(1/8),CR为0%,1年OS率为12.5%,PFS率为0%,P-GEMOX方案治疗组ORR为66.7%(6/9),CR为33.3%,1年OS率为55.6%,PFS率为11.1%,两组的ORR、OS、PFS率差异均有统计学意义(P<0.05)。单因素分析提示:低ECOG评分(0~1)、分期早、不合并B症状、血清LDH正常、低NKIPI评分(0~1)、EB病毒编码的小RNA(the EBV encoded small RNA,EBER)阴性患者有更长生存期,差异有统计学意义(P<0.001)。多因素分析提示:分期是影响患者预后的唯一因素,差异有统计学意义(P<0.05)。结论:早期患者采用P-GEMOX方案与CHOP方案化疗的疗效相当,晚期患者采用P-GEMOX方案化疗较CHOP方案可明显提高疗效且改善预后。临床分期是影响结外NK/T淋巴瘤预后的独立因素。
OBJECTIVE: To compare the short-term curative effect, long-term survival and safety of P-GEMOX with first-line therapy with conventional CHOP regimen in patients with extranodal NK / T lymphoma and to explore the prognostic factors. Methods: The clinical data of 45 patients with extranodal NK / T lymphoma in our hospital from 2010 to 2015 were retrospectively analyzed. The curative effect between the two treatment regimens was compared and prognostic factors were analyzed. Results: Twenty-eight patients with early extranodal NK / T lymphoma were treated with combination of radiotherapy and chemotherapy. The ORR was 85.7% (24/28) and CR was 82.1%. The ORR of CHOP combined with radiotherapy was 80.0% (12/15 ), CR was 73.3%, 2-year OS rate was 73.3%, PFS rate was 66.7%. ORR of P-GEMOX combined with radiotherapy was 92.3% (12/13), CR was 92.3%, 2-year OS was 92.3% and PFS was 92.3%, there was no significant difference in ORR, OS and PFS between the two groups (P> 0.05). Chemotherapy was the main treatment for 17 patients with advanced stage, with an ORR of 41.1% (7/17) and a CR of 17.6%. The ORR of the CHOP regimen was 12.5% (1/8), CR was 0% and the 1-year OS was 12.5 The PFS rate was 0%. The ORR of P-GEMOX regimen group was 66.7% (6/9), CR was 33.3%, the 1-year OS rate was 55.6% and the PFS rate was 11.1% PFS rate differences were statistically significant (P <0.05). Univariate analysis showed that the low ECOG score (0-1), early stage, unincorporated B symptoms, normal serum LDH, low NKIPI score (0-1), EBV encoded small RNA (EBER) Negative patients had longer survival, the difference was statistically significant (P <0.001). Multivariate analysis indicated that staging was the only factor affecting the prognosis of patients, the difference was statistically significant (P <0.05). CONCLUSIONS: Early treatment with P-GEMOX regimen is comparable to CHOP regimen, and advanced treatment with P-GEMOX regimen is superior to CHOP regimen in improving outcome and prognosis. Clinical stage is an independent factor affecting the prognosis of extranodal NK / T lymphoma.