Objective: To explore the prognostic factors of extracellular NK/T cell lymphoma (ENKTL) treated with pegaspargase/L-asparaginase. Methods: The clinical data of 656 ENKTL patients diagnosed at 11 medical centers in the Huaihai Lymphoma Working Group from March 2014 to April 2021 were retrospectively analyzed. The patients were randomly divided into two groups: a training set (460 cases) and a validation set (196 cases) at 7∶3, and the prognostic factors of the patients were analyzed. A prognostic scoring system was established, and the predictive performance of different models was compared. Results: Patients' median age was 46 (34, 57) years, with 456 males (69.5% ) and 561 nasal involvement (85.5% ). 203 patients (30.9% ) received a chemotherapy regimen based on L-asparaginase combined with anthracyclines, and the 5-year overall survival rate of patients treated with P-GEMOX regimen (pegaspargase+gemcitabine+oxaliplatin) was better than those treated with SMILE regimen (methotrexate+dexamethasone+cyclophosphamide+L-asparaginase+etoposide) (85.9% vs 63.8% ; P=0.004). The results of multivariate analysis showed that gender, CA stage, the Eastern Cooperative Oncology Group performance status (ECOG PS) score, HGB, and EB virus DNA were independent influencing factors for the prognosis of ENKTL patients (P<0.05). In this study, the predictive performance of the prognostic factors is superior to the international prognostic index, Korean prognostic index, and prognostic index of natural killer lymphoma. Conclusion: Gender, CA stage, ECOG PS score, HGB, and EB virus DNA are prognostic factors for ENKTL patients treated with pegaspargase/L-asparaginase.
目的： 探索培门冬酶/左旋门冬酰胺酶治疗结外NK/T细胞淋巴瘤（ENKTL）的预后影响因素。 方法： 回顾性分析自2014年3月至2021年4月在淮海淋巴瘤协作组11所医疗中心确诊的656例ENKTL患者的临床资料，将患者按照7∶3随机分为训练集（460例）和验证集（196例）两个队列，分析患者的预后影响因素。建立预后评分系统，比较不同模型的预测性能。 结果： 患者的中位年龄为46（34，57）岁，男456例（69.5%），鼻部受累561例（85.5%）。203例（30.9%）患者采用了以左旋门冬酰胺酶联合蒽环类药物为基础的化疗方案，接受P-GEMOX（培门冬酶+吉西他滨+奥沙利铂）方案治疗患者的5年总生存率优于接受SMILE（甲氨蝶呤+地塞米松+异环磷酰胺+左旋门冬酰胺酶+依托泊苷）方案的患者（85.9%对63.8%，P＝0.004）。多因素分析结果显示性别、CA分期、美国东部肿瘤协作组体能状况（ECOG PS）评分、HGB、EB病毒DNA是ENKTL患者预后的独立影响因素（P值均<0.05）。基于本研究筛选出的预后因素的预测性能优于国际预后指数、韩国预后指数和自然杀伤淋巴瘤预后指数。 结论： 性别、CA分期、ECOG PS评分、HGB和EB病毒DNA是接受培门冬酶/左旋门冬酰胺酶治疗的ENKTL患者的预后影响因素。.
Keywords: Asparaginase; Lymphoma, extranodal NK-T-cell; Pegaspargase; Prognosis.