Blood Res.  2021 Jun;56(2):72-78. 10.5045/br.2021.2020328.

Clinical impact of lymphatic spread in patients with limited-stage upper aerodigestive tract NK/T cell lymphoma

Affiliations
  • 1Department of Hematology, Hanyang University Hanmaeum Changwon Hospital, Changwon, Busan, Korea
  • 2Department of Hematology-Oncology, Pusan National University Hospital Medical Research Institute, Busan, Korea
  • 3Department of Oncology, Dong-A University Hospital, Busan, Korea
  • 4Department of Hematology, Busan Haeundae Paik Hospital, Busan, Korea
  • 5Department of Hematology, Busan Paik Hospital, Busan, Korea

Abstract

Background
We investigated whether distance max , that is, the degree of distance between the upper aerodigestive tract (UAT) mass and the farthest pathologic lymph node, was significantly associated with survival in patients with limited-stage UAT natural killer/T cell lymphoma (NKTCL).
Methods
A total of 157 patients who received chemotherapy (CTx) with/without radiotherapy (RTx) were enrolled.
Results
In the survival analysis, an elevated lactate dehydrogenase level [progression-free survival (PFS): hazard ratio (HR), 2.948; 95% confidence interval (CI), 1.606‒5.404; P <0.001; overall survival (OS): HR, 2.619; 95% CI, 1.594‒4.822; P =0.003], short distance max (PFS: HR, 0.170; 95% CI, 0.071‒0.410; P <0.001; OS: HR, 0.142; 95% CI, 0.050‒0.402; P < 0.001), and CTx combined with RTx (HR, 0.168; 95%CI, 0.079‒0.380; P < 0.001; OS: HR, 0.193; 95% CI, 0.087‒0.429; P <0.001) had an independent predictive value for PFS and OS.
Conclusion
The evaluation of the degree of lymphatic spread and local control by CTx combined with RTx is essential in patients with limited-stage UAT NKTCL.

Keyword

Upper aerodigestive tract; Radiotherapy; Natural killer/T cell lymphoma

Figure

  • Fig. 1 Receiver operating characteristic (ROC) curves to identify optimal cutoff value of maximum distance (distancemax) from primary extra nodal site to the farthest lymph node, and maximum standard uptake value (SUVmax) in patients with limited stage upper aerodigestive tract natural killer/T cell lymphoma. The calculated optimal cutoffs for distancemax and SUVmax were 10.8 and 7.1 respectively. In addition, the area under the ROC curve (AUC) values for distancemax and SUVmax were 0.874 and 0.632, respectively. The AUC value for distancemax was significantly higher than that for SUVmax (P<0.001).

  • Fig. 2 Survival analysis according to distancemax in patients with limited stage upper aerodigestive tract natural killer/T cell lymphoma. Differences in the short distancemax group (N=67) and long distancemax group (N=90) were significant (progression-free survival, P<0.001; Fig. 2A; OS, P<0.001; Fig. 2B).

  • Fig. 3 Prognosis according to degree of lymphatic spread and therapeutic modality. In the Kaplan-Meier survival curve, lymphoma involvement of short distancemax in patients treated with CTx and RTx had the most favorable PFS and OS (PFS, P<0.001; Fig. 3A; OS, P<0.001, Fig. 3B). Meanwhile, involvement of long distancemax in patients received only CTx had worst PFS and OS (PFS, P<0.001, Fig. 3A; OS, P<0.001, Fig. 3B). Lymphoma involvement of short distancemax in patients treated with only CTx and long distancemax involvement in patients who received chemotherapy combined with radiotherapy did not have significant survival differences (PFS, P=0.431; OS, P=0.578).


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