以眼部症状为突出表现的鼻NK/T细胞淋巴瘤42例临床分析

胡真真; 王英; 金晓朗

doi:10.13201/j.issn.1001-1781.2018.21.012

以眼部症状为突出表现的鼻NK/T细胞淋巴瘤42例临床分析

- 郑州大学第一附属医院鼻科(郑州, 450052)

详细信息

通讯作者: 王英, E-mail:bike2202@163.com

中图分类号: R739.6

收稿日期: 2018-07-21

Clinical analysis of 42cases of nasal natural killer/T-cell lymphoma prominently presenting as ocular symptoms

- Department of Nose, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China

More Information

Corresponding author: WANG Ying, E-mail: bike2202@163.com

Received Date: 21 July 2018

摘要

摘要: 目的: 探讨以眼部症状为突出表现的鼻NK/T细胞淋巴瘤(NKTL)的临床特点及预后。方法: 对2011-01-2017-12期间收治的42例以眼部症状为突出表现的鼻NKTL患者进行回顾性队列研究。结果: 全部患者治疗后完全缓解19例,部分缓解9例,总有效率为66.67%。中位随访时间为39个月,共18例患者死亡。该研究中,患者的性别、年龄>60岁均与预后无关(均P>0.05)。放化疗联合治疗者较单纯放疗或化疗者的3年生存率高(73.3%、16.7%,P<0.01)。伴有B症状者3年生存率为41.7%,与预后无关(P>0.05)。EBV-DNA阳性者预后较差(P<0.01)。Ⅰ期和Ⅱ期患者较Ⅲ期和Ⅳ期患者的预后较好(P<0.01)。国际预后指数 ≤ 1分者较 ≥ 2分者预后好(83.3%、37.5%,P<0.01)。结论: 以眼部症状为突出表现的鼻NKTL早期诊断困难,易误诊。应尽早通过病理活检及免疫组织化学检测明确诊断,必要时应行EBER原位杂交来协助诊断。
- 鼻NK/T细胞淋巴瘤 /
- 眼部症状 /
- 诊断 /
- 预后
Abstract: Abstract Objective: To investigate the clinical features and prognosis of nasal natural killer/T-cell lymphoma(NKTL) with obvious ocular symptoms.Method: We retrospectively analyzed the clinical data of 42 patients with nasal NKTL who prominently showed eye symptoms and were treated from January 2011 to December 2017.Result: After treatment, the patients received complete remission(CR) in 19 cases and partial remission(PR) in 9 cases. The total effective rate was 66.67%. Median follow-up time was 39 months and 18 patients died. In this study, there was no correlation between sex and prognosis(P>0.05). Age>60 years was not related to the prognosis of the patients(P>0.05). The 3-year survival rate of patients treated with radiotherapy and chemotherapy was higher than that of patients treated with radiotherapy or chemotherapy alone(73.3%, 16.7%,P<0.01). The 3-year survival rate of patients with B symptoms was 41.7%, which was not related to prognosis(P>0.05). The prognosis of EBV-DNA positive patients was poor(P<0.01). Twenty-six patients with stage Ⅰ and Ⅱ had a better prognosis(P<0.01). Patients with international prognostic index(IPI) ≤ 1 had a better prognosis than those with IPI ≥ 2(83.3%, 37.5%,P<0.01).Conclusion: Nasal NKTL lymphomas with prominent ocular symptoms are difficult to diagnose early and easy to be misdiagnosed. Clinicians should make a definite diagnosis by pathological biopsy and immunohistochemistry as soon as possible, and assist in diagnosis by EBER in situ hybridization if necessary.
- nasal natural killer/T-cell lymphoma /
- ocular symptoms /
- diagnosis /
- prognosis

HTML全文

参考文献(17)

[1]	NIU S Q, YANG Y, LI Y Y, et al.Primary site and regional lymph node involvement are independent prognostic factors for early-stage extranodal nasal-type natural killer/T cell lymphoma[J].Chin J Cancer, 2016, 35:34-37.
[2]	ABE R Y, PINTO R D, BONFITTO J F, et al.Ocular masquerade syndrome associated with extranodal nasal natural killer/T-cell lymphoma:case report[J].Arq Bras Oftalmol, 2012, 75:430-432.
[3]	MA H H, QIAN L T, PAN H F, et al.Treatment outcome of radiotherapy alone versus radiochemotherapy in early stage nasal natural killer/T-cell lymphoma[J].Med Oncol, 2010, 27:798-806.
[4]	WU R Y, LIU K, WANG W H, et al.Patterns of primary tumor invasion and regional lymph node spread based on magnetic resonance imaging in early-stage nasal NK/T-cell lymphoma:implications for clinical target volume definition and prognostic significance[J].Int J Radiat Oncol Biol Phys, 2017, 97:50-59.
[5]	KIESSLING S Y, SOYKA M B, HUBER G F, et al.Delayed diagnosis of sinonasal lymphoma due to bilateral manifestation[J].Eur Arch Otorhinolaryngol, 2017, 274:823-827.
[6]	CHESON B D, HORNING S J, COIFFIER B, et al.Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas.NCISponsored International Working Group[J].J Clin Oncol, 1999, 17:1244-1247.
[7]	ZUHAIMY H, AZIZ H A, VASUDEVAN S, et al.Extranodal natural killer/T-cell lymphoma presenting as orbital cellulitis[J].GMS Ophthalmol Case, 2017, 7:c4.
[8]	WANG X, GONG Z, LI S X, et al.Extranodal nasaltype natural killer/T-cell lymphoma with penile involvement:a case report and review of the literature[J].BMC Urol, 2017, 17:77-81.
[9]	YOO J H, KIM S Y, JUNG K B, et al.Intraocular involvement of a nasal natural killer T-cell lymphoma:a case report[J].Korean J Ophthalmol, 2012, 26:54-57.
[10]	李晔雄, 姚波.鼻腔NK/T细胞淋巴瘤的临床病理特点及治疗[J].中华放射肿瘤学杂志, 2004, 13 (3):172-176.
[11]	LUO H, QUAN X, SONG X Y, et al.Red blood cell distribution width as a predictor of survival in nasaltype, extranodal natural killer/T-cell lymphoma[J].Oncotarget, 2017, 8:92522-92535.
[12]	HUANG Y, YANG J, LIU P, et al.Intensity-modulated radiation therapy followed by GDP chemotherapy for newly diagnosed stageⅠ/Ⅱextranodal natural killer/T cell lymphoma, nasal type[J].Ann Hematol, 2017, 96:1477-1483.
[13]	王海, 张曙, 石群立.鼻型NK/T细胞淋巴瘤研究进展[J].中华肿瘤防治杂志, 2008, 15 (24):1909-1913.
[14]	ZHANG L, LI S, JIA S, et al.The DDGP (cisplatin, dexamethasone, gemcitabine, and pegaspargase) regimen for treatment of extranodal natural killer (NK)/T-cell lymphoma, nasal type[J].Oncotarget, 2016, 7:58396-58404.
[15]	KIM T M, PARK Y H, LEE S Y, et al.Local tumor invasiveness is more predictive of survival than International Prognostic Index in stageⅠ (E)/Ⅱ (E) extranodal NK/T-cell lymphoma, nasal type[J].Blood, 2005, 106:3785-3790.
[16]	SUZUKI R, SUZUMIYA J, YAMAGUCHI M, et al.Prognostic factors for mature natural killer (NK) cell neoplasms:aggressive NK cell leukemia and extranodal NK cell lymphoma, nasal type[J].Ann Oncol, 2010, 21:1032-1040.
[17]	LIANG R, WANG Z, BAI Q X, et al.Natural Killer/Tcell lymphoma, nasal type:a retrospective clinical analysis in North-Western China[J].Oncol Res Treat, 2016, 39:45-52.