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Clinical features, prognostic stratification, and treatment of advanced-stage non-nasal type extranodal natural killer/T-cell lymphoma: a multi-institutional real-world study

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Abstract

The present study aimed to investigate the clinical features, prognosis, and treatment of advanced-stage non-nasal type extranodal natural killer/T-cell lymphoma (ENKTCL). This real-world study retrospectively reviewed 56 newly diagnosed advanced-stage non-nasal type ENKTCL patients from two large-scale Chinese cancer centers in the last 10–15 years and screened 139 newly diagnosed advanced-stage nasal type ENKTCLs admitted during the same period for comparison. The non-nasal type ENKTCLs exhibited significantly higher Ki-67 expression levels compared to nasal type disease (P = 0.011). With a median follow-up duration of 75.03 months, the non-nasal group showed slightly inferior survival outcomes without statistically significant differences compared to the nasal group (median overall survival (OS): 14.57 vs. 21.53 months, 5-year OS: 28.0% vs. 38.5%, P = 0.120). Eastern Cooperative Oncology Group (ECOG) score ≥ 2 (hazard ratio (HR) = 2.18, P = 0.039) and lactic dehydrogenase (LDH) elevation (HR = 2.44, P = 0.012) were significantly correlated with worse OS in the non-nasal group. First-line gemcitabine-based chemotherapy regimens showed a trend toward slightly improved efficacy and survival outcomes compared to non-gemcitabine-based ones in the present cohort of non-nasal ENKTCLs (objective response rate: 91.7% vs. 63.6%, P = 0.144; complete response rate: 50.0% vs. 33.3%, P = 0.502; median progression-free survival: 10.43 vs. 3.40 months, P = 0.106; median OS: 25.13 vs. 9.30 months, P = 0.125), which requires further validation in larger sample size studies. Advanced-stage non-nasal type patients could achieve comparable prognosis with nasal cases after rational therapy. The modified nomogram-revised index (including age, ECOG score, and LDH) and modified international prognostic index (including age, ECOG score, LDH, and number of extranodal involvement) functioned effectively for prognostic stratification in non-nasal type ENKTCLs.

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Data availability

The original data in this study are available from the corresponding authors on reasonable request.

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Acknowledgements

The authors would like to thank all the participants who contributed to the study and the Chinese Geriatric Oncology Society Scientific Research Fund (CGOS-06-2014-1-1-01600) for their sponsorship.

Funding

The study was sponsored by the Chinese Geriatric Oncology Society Scientific Research Fund (CGOS-06–2014-1–1-01600).

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Authors and Affiliations

  1. Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China

    Yu-Ce Wei, Chang-Gong Zhang, Di Zhang, Yue Chai & Mei Dong

  2. Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China

    Wei-Xin Liu, Bao-Min Zheng & Wei-Hu Wang

  3. Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Haidian District, No. 52, Fucheng Road, Beijing, 100142, China

    Fei Qi, Yan Xie, Wei-Ping Liu, Yu-Qin Song & Jun Zhu

  4. Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Bo Chen, Hui Fang, Shu-Nan Qi & Ye-Xiong Li

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  1. Yu-Ce Wei
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Contributions

M. D. and Y.-C. W. designed the study. M. D., J. Z., Y.-Q. S., W.-H. W., Y.-X. L., C.-G. Z., Y. X., W.-P. L., W.-X. L., B.-M. Z., B. C., H. F., and S.-N. Q. contributed to the patient collection and data acquisition. F. Q., D. Z., and Y. C. helped with data collection and registration. Y.-C. W. and W.-X. L. performed statistical analysis and interpreted the data. Y.-C. W., W.-X. L., and M. D. wrote the manuscript. Y.-C. W., W.-X. L., Y.-X. L., W.-H. W., Y.-Q. S., J. Z., and M. D. critically reviewed the article. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Yu-Qin Song, Jun Zhu or Mei Dong.

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Ethics approval

The present study was approved by the independent ethics committee of Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (2022111713093202) and conducted in accordance with the Declaration of Helsinki.

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Written informed consent was exempted as a retrospective, non-interventional study.

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The authors declare no competing interests.

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Wei YC and Liu WX contributed equally as the first authors. Song YQ Zhu J and Dong M contributed equally and share corresponding authorship.

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Wei, YC., Liu, WX., Qi, F. et al. Clinical features, prognostic stratification, and treatment of advanced-stage non-nasal type extranodal natural killer/T-cell lymphoma: a multi-institutional real-world study. Ann Hematol 103, 163–174 (2024). https://doi.org/10.1007/s00277-023-05455-4

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