Abstract：Objective To analyze the incidence and risk factors for distant lymph node metastasis in stage ⅠE and ⅡE upper aerodigestive tract natural killer (NK)/T-cell lymphoma (UADT-NKTCL) after treatment. Methods From December 1979 to December 2012, 468 patients with stage ⅠE and ⅡE UADT-NKTCL were treated;170 patients were treated with radiotherapy alone, 19 patients with chemotherapy alone, 278 patients with radiotherapy and chemotherapy, and one patient with anti-inflammation therapy. The incidence of distant lymph node metastasis was calculated by the Kaplan-Meier method. Results The median follow-up was 35 months. Thirty-two patients had distant lymph node metastasis, accounting for 6.8% of all patients and 19.8% of 162 patients who had disease progression or recurrence;the 2-year incidence of distant lymph node metastasis was 6.4%. Twenty-three (71.9%) of the 32 patients had distant organ metastasis. Mesenteric lymph nodes were most affected in distant lymph node metastasis. The univariate analysis showed that extranasal UADT-NKTCL, stage ⅡE, and not achieving a complete response (non-CR) after the first course of treatment were high-risk factors for distant lymph node metastasis. The multivariate analysis showed that stage ⅡE and non-CR after the first course of treatment were identified as independent risk factors for long-term recurrence, with hazard ratios of 2.82(1.37—5.82, P=0.005) and 3.01(1.16—7.78, P=0.023). For patients with stage ⅡE disease, those receiving combined-modality therapy had a significantly lower incidence of distant lymph node metastasis than those receiving radiotherapy alone and chemotherapy alone (2-year incidence of distant lymph node metastasis:12.5% vs 35.1% and50.0%, P=0.011). Conclusions The incidence of distant lymph node metastasis is low in patients with stage ⅠE and ⅡE UADT-NKTCL after treatment. However, the patients with stage ⅡE disease or non-CR after the first course of treatment still have a high risk of distant lymph node metastasis. Patients with stage ⅡE UADT-NKTCL should be treated by combined-modality therapy to reduce the incidence of distant lymph node metastasis.
Chen Bo,Li Yexiong,Liu Qingfeng et al. Clinical features of distant lymph node metastasis in early-stage extranodal nasal-type NK/T-cell lymphoma after treatment[J]. Chinese Journal of Radiation Oncology, 2014, 23(3): 181-186.
[1] Yang QP, Zhang WY, Yu JB, et al. Subtype distribution of lymphomas in Southwest China:analysis of 6,382 cases using WHO classification in a Single Institution[J/OL]. Diagn Pathol,2011,6:77[2014-03-19]. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3179701/. [2] Sun J, Yang Q, Lu Z, et al. Distribution of lymphoid neoplasms in China:analysis of 4,638 cases according to the World Health Organization classification[J]. Am J Clin Pathol,2012,138:429-434. [3] Li YX, Coucke PA, Li JY, et al. Primary non-Hodgkin′s lymphoma of the nasal cavity:prognostic significance of paranasal extension and the role of radiotherapy and chemotherapy[J]. Cancer,1998,83:449-456. [4] Li YX, Fang H, Liu QF, et al. Clinical features and treatment outcome of nasal-type NK/T-cell lymphoma of Waldeyer ring[J]. Blood,2008,112:3057-3064. [5] Li YX, Liu QF, Fang H, et al. Variable clinical presentations of nasal and Waldeyer ring natural killer/T-cell lymphoma[J]. Clin Cancer Res,2009,15:2905-2912. [6] Au WY, Weisenburger DD, Intragumtornchai T, et al. Clinical differences between nasal and extranasal natural killer/T-cell lymphoma:a study of 136 cases from the international peripheral T-cell lymphoma project[J]. Blood,2009,113:3931-3937. [7] Li YX, Yao B, Jin J, et al. Radiotherapy as primary treatment for stage ⅠE and ⅡE nasal natural killer/T-cell lymphoma[J].J Clin Oncol,2006,24:181-189. [8] Vazquez A, Khan MN, Blake DM, et al. Extranodal natural killer/T-Cell lymphoma:a population-based comparison of sinonasal and extranasal disease[J]. Laryngoscope,2014,124:888-895. [9] Li S, Feng X, Li T, et al. Extranodal NK/T-cell lymphoma, nasal type:a report of 73 cases at MD Anderson Cancer Center[J]. Am J Surg Pathol,2013,37:14-23. [10] Li YX, Liu QF, Wang WH, et al. Failure patterns and clinical implications in early stage nasal natural killer/T-cell lymphoma treated with primary radiotherapy. Cancer,2011,117:5203-5211. [11] Chim CS, Ma SY, Au WY, et al. Primary nasal natural killer cell lymphoma:long-term treatment outcome and relationship with the International Prognostic Index[J]. Blood,2004,103:216-221. [12] Li YX, Wang H, Jin J, et al. Radiotherapy alone with curative intent in patients with stage Ⅰ extranodal nasal-type NK/T-cell lymphoma[J]. Int J Radiat Oncol Biol Phys,2012,82:1809-1815. [13] Kim K, Chie EK, Kim CW, et al. Treatment outcome of angiocentric T-cell and NK/T-cell lymphoma, nasal type:radiotherapy versus chemoradiotherapy[J]. Jpn J Clin Oncol,2005,35:1-5. [14] Bi XW, Li YX, Fang H, et al. High-dose and extended-field intensity modulated radiation therapy for early-stage NK/T-cell lymphoma of Waldeyer′s ring:dosimetric analysis and clinical outcome[J]. Int J Radiat Oncol Biol Phys,2013,87:1086-1093. [15] Li CC, Tien HF, Tang JL, et al. Treatment outcome and pattern of failure in 77 patients with sinonasal natural killer/T-cell or T-cell lymphoma[J]. Cancer,2004,100:366-375. [16] Koom WS, Chung EJ, Yang WI, et al. Angiocentric T-cell and NK/T-cell lymphomas:radiotherapeutic viewpoints[J]. Int J Radiat Oncol Biol Phys,2004,59:1127-1137. [17] Ma X, Guo Y, Pang Z, et al. A randomized phase Ⅱ study of CEOP with or without semustine as induction chemotherapy in patients with stage ⅠE/ⅡE extranodal NK/T-cell lymphoma, nasal type in the upper aerodigestive tract[J]. Radiother Oncol,2009,93:492-497. [18] Avilés A, Neri N, Fernéndez R, et al. Combined therapy in untreated patients improves outcome in nasal NK/T lymphoma:results of a clinical trial[J]. Med Oncol,2013,30:637. [19] Zhang J, Zhu MY, Wang L, et al."Sandwich" chemotherapy (CT) with radiotherapy (RT) improves outcomes in patients with stage ⅠE/ⅡE extranodal natural killer (NK)/T-cell Lymphomas[J]. Asian Pac J Cancer Prev,2013,14:4061-4066. [20] 陈波,李晔雄,刘清峰,等.早期结外鼻型NK/T细胞淋巴瘤疗后远期复发因素分析[J].中华放射肿瘤学杂志,2013,22:175-179. [21] Wang H, Li YX, Wang WH, et al. Mild toxicity and favorable prognosis of high-dose and extended involved-field intensity-modulated radiotherapy for patients with early-stage nasal NK/T-cell lymphoma[J]. Int J Radiat Oncol Biol Phys,2012,82:1115-1121. [22] Cheung MM, Chan JK, Lau WH, et al. Early stage nasal NK/T-cell lymphoma:clinical outcome, prognostic factors, and the effect of treatment modality[J]. Int J Radiat Oncol Biol Phys,2002,54:182-190. [23] Fang H, Jin J, Wang WH, et al. Prognostic factors and treatment outcomes for patients with stage Ⅱ extranodal nasal-type natural killer/T-cell lymphoma of the upper aerodigestive tract[J]. Leuk Lymphoma,2014, In press.
2014, Vol. 23 
