摘要目的 比较原发韦氏环弥漫性大B细胞淋巴瘤(DLBCL)与结外鼻型NK/T细胞淋巴瘤( EN KTCL)的临床特征和顶后差异.方法 对2000-2008年间本院收治的122例DLBCL和44例ENKTCL进行回顾分析.DLBCL通常4～6周期CHOP方案化疗后加累及野放疗,早期NKTCL单纯扩大野放疗或加辅助化疗或放疗前加短周期(1～3周期)CHOP方案化疗.Kaplan-Meier法计算生存率并Logrank检验组间差异和单因素预后分析.结果 随访率为82％,DLBCL和ENKTCL随访时间满5年者分别为32例和15例.DLBCL多见于扁桃体并伴有颈潜巴结累及、ENKTCL多见年轻男性、鼻咽Ⅰ期病变、B症状和侵犯周围结构.DLBCL和ENKTCL的5年总生存率、无进展生存率分别为74％、67％和68％、59％(x2=0.53、1.06,P=0.468、0.303)；Ⅰ+Ⅱ期的5年总生存率、无进展生存率分别为79％ 、76％和72％、62％(x2=1.20、2.46,P=0.273、0.117).单因素分析显示年龄＞60岁、乳酸脱氢酶升高、东部肿瘤协作组评分＞1、国际预后指数评分≥1、Ⅲ+Ⅳ期病变和大肿块与DLBCL的预后相关(x2=9.40、12.72、6.15、10.36、12.48、5.53,P=0.002、0.000、0.013、0.001、0.000、0.019),而国际预后指数评分≥1和年龄＞60岁与ENKTCL的预后相关(x2=3.98、8.41,P=0.046、0.004).结论 原发韦氏环的DLBCL与ENKTCL临床特征不同,但不同治疗原则下两者预后相似.

abstractsObjective This study aimed to compare the clinical characteristics and prognoses of primary Waldeyer's ring diffuse large B-cell lymphoma (DLBCL) and extranodal nasal-type NK/T-cell lymphoma ( ENKTCL).Methods From 2000 to 2008,122 patients with primary Waldeyer's ring DLBCL and 44 patients with primary Waldeyer' s ring ENKTCL consecutively diagnosed were retrospectively compared.Patients with DLBCL usually received 4-6 cycles of CHOP-based chemotherapy followed by involved-field radiotherapy.Patients with early stage ENKTCL usually received extended-field radiotherapy with or without subsequent chemotherapy,or short courses ( 1 - 3 cycles ) of chemotherapy followed by radiotherapy.Kaplan-Meier method was used for survival analysis.Logrank method was used for univariate analysis.Results The follow-up rate was 82％.The number of patients followed 5 years were 32 and 15 in DLBCL and ENKTCL.DLBCL mainly presented with stage Ⅱ tonsillar disease with regional lymph node involvement.ENKTCL occurred predominately in young males,as nasopharyngeal stage I disease with B symptoms and involving adjacent structures.The 5-year overall survival (OS) and progression-free survival (PFS) rates were 74％ and 67％ in DLBCL,and 68％ and 59％ in ENKTCL (x2=0.53,1.06,P=0.468,0.303),respectively.In stage Ⅰ and Ⅱ diseases,the 5-year OS and PFS rates were 79％ and 76％ for DLBCL compared to 72％ and 62％ for ENKTCL (x2 =1.20,2.46,P=0.273,0.117).On univariate analysis,age ＞ 60 years,elevated lactate dehydrogenase,eastern cooperative oncology group performance status ＞ 1,international prognosis index ( IPI ) score ≥ 1,stage Ⅲ/Ⅳ diseases and bulky disease were associated with unfavorable survival for DLBCL (x2=9.40,12.72,6.15,10.36,12.48,5.53,P=0.002,0.000,0.013,0.001,0.000,0.019),and only age＞60 years and IPI score ≥ 1 were associated with poor survival for ENKTCL (x2 =3.98,8.41,P =0.046,0.004).Conclusions These results indicate that remarkable clinical disparities exist between DLBCL and ENKTCL in Waldeyer's ring. Different treatment strategies for each can result in similarly favorable prognoses.