Extranodal NK/T-Cell Lymphoma: A Comparative Clinicopathological Study According to Survival Outcome.

BACKGROUND Extranodal NK/T-cell lymphoma is notable for its unique behavior; Many patients die before 1 year from the diagnosis. However, the patients who survive the first year from the diagnosis live for longer period. Known prognostic factors were insufficient to explain this unique pattern. The objective of this study was to investigate clinicopathological features according to survival outcome(OS<1 yr vs OS ≥1 yrs).

METHODS We reviewed 28 patients who diagnosed as extranodal NK/T cell lymphoma from March, 1995 to July, 2006. Patients were treated with chemotherapy alone or chemoradiotherapy. Real-time PCR was done from the tissue of the biopsy specimen to quantify the Epstein-Barr virus load.

RESULTS Of the 28 patients, 14 patients(50%) achieved a complete remission(CR). Median survival was 46 months(range, 1–114 months). The B symptoms, IPI score, stage, ECOG status, first treatment response was significant prognostic factor (P<0.05). However ECOG status the only significant prognostic factor by using mutivariate analysis (P=0.001). Seventeen patients (61%) expired; 12 of those patients died during the first year of diagnosis. Thus we divided them into 2 groups; who lived more than 1 year and who lived less than 1 year. The ECOG status, first treatment response rate was different between the two groups significantly(p<0.05). All patients showed positive EBV by PCR. However, there was no significant difference in EBV load between these two groups. (p=0.113)

CONCLUSION The ECOG status, and response to the first treatment related to the survival of first year from the diagnosis. For the patients with poor performance status, and failure to achieve CR after the first treatment, more aggressive treatment should be considered to improve survival. In our study, EBV load measured on the paraffin tissue failed to correlate with survival.

Univariate Analysis of Overall survival

Prognostic Factors .	Median OS(months) .	P value .
Age
>60yrs	33
<60yrs	10	0.783
Type
Nasal	33
Nasal type	5	0.225
B symptom
Yes	5
No	42	0.021
IPI
Low/Low-intermediate	42
High-intermediate/High	2	0.002
Stage
I/II	42
III/IV	2	0.001
ECOG
0,1	45
2,3,4	2	0.001
LDH
Normal	33
High	17	0.720
EBV
load(copies/ug DNA)(n=22)	46	0.228
Treatment
C/T alone	5
C/T and R/T	42	0.196
treatment response
CR	45
No-CR	14	0.0127

Prognostic Factors .	Median OS(months) .	P value .
Age
>60yrs	33
<60yrs	10	0.783
Type
Nasal	33
Nasal type	5	0.225
B symptom
Yes	5
No	42	0.021
IPI
Low/Low-intermediate	42
High-intermediate/High	2	0.002
Stage
I/II	42
III/IV	2	0.001
ECOG
0,1	45
2,3,4	2	0.001
LDH
Normal	33
High	17	0.720
EBV
load(copies/ug DNA)(n=22)	46	0.228
Treatment
C/T alone	5
C/T and R/T	42	0.196
treatment response
CR	45
No-CR	14	0.0127

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Multivariate Analysis of Overall survival

Prognostic Factors .	Hazad Ratio .	95% CI .	P .
B symptom
No	1.00
Yes	0.97	0.11–8.58	0.980
IPI score
Low/Low-inermediate	1.00
High-intermediate/High	1.35	0.25–7.26	0.730
Stage
I,II	1.00
III,IV	0.60	0.06–6.12	0.668
ECOG
0,1	1.00
2,3,4	6.94	2.23–21.55	0.001
Treatment response
CR	1.00
No-CR	1.98	0.56–6.96	0.287

Prognostic Factors .	Hazad Ratio .	95% CI .	P .
B symptom
No	1.00
Yes	0.97	0.11–8.58	0.980
IPI score
Low/Low-inermediate	1.00
High-intermediate/High	1.35	0.25–7.26	0.730
Stage
I,II	1.00
III,IV	0.60	0.06–6.12	0.668
ECOG
0,1	1.00
2,3,4	6.94	2.23–21.55	0.001
Treatment response
CR	1.00
No-CR	1.98	0.56–6.96	0.287

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Fig. 2

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Overall survival according to survival outcome (OS<1 year vs OS ≥ 1 years). The patients who survive more than 1 year showed relativily good prognosis.

Fig. 2

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Overall survival according to survival outcome (OS<1 year vs OS ≥ 1 years). The patients who survive more than 1 year showed relativily good prognosis.

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