Annals of Oncology Advance Access published online on April 2, 2008
Annals of Oncology, doi:10.1093/annonc/mdn147
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Clinical heterogeneity of extranodal NK/T-cell lymphoma, nasal type: a national survey of the Korean Cancer Study Group
1 Department of Internal Medicine
2 Department of Pathology, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine
3 Department of Internal Medicine, Korea Cancer Center Hospital, Seoul
4 Department of Internal Medicine, Busan National University College of Medicine, Busan
5 Department of Internal Medicine, College of Medicine, Catholic University, Seoul
6 Department of Internal Medicine, Dong-A University Medical Center, Busan
7 Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul
8 Department of Internal Medicine, Inha University College of Medicine, Incheon
9 Department of Internal Medicine, Chungnam National University College of Medicine, Daejon
10 Department of Internal Medicine, Korea University College of Medicine, Seoul
11 Department of Internal Medicine, Kyungbook National University College of Medicine, Daegu
12 Department of Internal Medicine, Hallym University College of Medicine, Seoul
13 Department of Internal Medicine, Fatima Hospital, Daegu
14 Department of Internal Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul
15 Department of Internal Medicine, Chonbuk National University College of Medicine, Chonju
16 Department of Internal Medicine, Gyeongsang National University Hospital, Jinju
17 Department of Internal Medicine, Inje University Paik Hospital, Seoul, Korea
* Correspondence to: Dr D. S. Heo, Department of Internal Medicine, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea. Tel: +82-2-2072-2857; Fax: +82-2-742-6689; E-mail: heo1013{at}snu.ac.kr
Background: This national survey was undertaken to propose the classification of extranodal natural killer (NK)/T-cell lymphoma (NTCL) subtypes and to clarify a clinical heterogeneity.
Patients and methods: Two hundred and eighty patients newly diagnosed as NTCL were enrolled from 22 Korean medical centers. Two subsets were compared: one involving the upper aerodigestive tract (UAT) and another involving the non-upper aerodigestive tract (NUAT) region, which comprises the skin, gastrointestinal tract, and liver or soft tissues. Clinical prognostic factors, survival outcomes, and independent predictors for survival were compared between each subset.
Results: NUAT-NTCL (59 patients) had significantly higher proportions of disseminated disease, aggressive biologic features, and unfavorable host reactions compared with UAT-NTCL (221 patients). NUAT-NTCL had shortened 5-year overall survival (OS) (22% versus 41%, P = 0.001). Ann Arbor staging, the International Prognostic Index, and the NTCL prognostic index failed to predict the OS of NUAT-NTCL, but did predict the OS in UAT-NTCL. Independent predictors for OS by multivariate analyses differed between each subset. In the NUAT subset, extranodal sites and regional nodes predicted the OS, while Ann Arbor staging, age, performance status, and lactate dehydrogenase level predicted the OS in the UAT subset.
Conclusion: NUAT-NTCL may represent a distinctive disease entity in terms of clinical factors, independent predictors, and survival outcomes.
clinical heterogeneity, NK/T-cell lymphoma, prognostic factor
These authors contributed equally to this work. Received for publication October 27, 2007. Revision received January 7, 2008. Revision received March 2, 2008. Accepted for publication March 4, 2008.