Objective To investigate the differences in clinical features and prognosis between patients with stage Ⅰ_E—Ⅱ_E nasal cavity natural killer (NK)/T-cell lymphoma (NC-NKTL) and Waldeyer′s ring NK/T-cell lymphoma (WR-NKTL). Methods A retrospective analysis was performed on 273 patients with NK/T lymphoma who were initially treated in our hospital from January 1991 to December 2011. Of these patients, 184 had Ann Arbor stage Ⅰ_E disease, and 89 had stage Ⅱ_E disease;209 had NC-NKTL, and 64 had WR-NKTL. A total of 258 patients (94.5%) were first treated with chemotherapy. The majority of patients received CHOP or CHOP-like chemotherapy. The median dose of radiotherapy was 54 Gy. Results Compared with NC-NKTL patients, WR-NKTL patients had significantly higher percentages of individuals in stage Ⅱ_E and individuals with B symptoms (P<0.05 for both). The overall response rates of the two groups after treatment were similar (88.7% vs 87.9%, P=0.869). The follow-up rate was 96.3%. 196 patients were followed up for at least 5 years. The 5-year overall survival (OS) and progression-free survival (PFS) were 52.6% and 41.4%, respectively. The 5-year OS of NC-NKTL patients was nonsignificantly higher than that of WR-NKTL patients (57.0% vs 39.0%, P=0.062), while the 5-year PFS of NC-NKTL patients was significantly higher than that of WR-NKTL patients (46.7% vs 25.8%, P=0.019). Conclusions Patients with early-stage WR-NKTL are more prone to systemic symptoms and cervical lymph node metastasis and have poorer prognosis, as compared with patients with early-stage NC-NKTL, so radiotherapy and prophylactic irradiation should be considered in early stage.