A TNM Staging System for Nasal NK/T-Cell Lymphoma

Abstract

Ann Arbor stage has limited utility in the prognostication and treatment decision making in patients with NK/T-cell lymphoma (NKTCL), as NKTCL is almost exclusively extranodal and the majority is localized at presentation for which radiotherapy is the most important treatment and local invasiveness is the most important prognostic factor. In this study, we attempted to establish a TNM (Tumor-Node-Metastasis) staging system for nasal NKTCL (N-NKTCL). The staging rules of other head and neck cancers were used as reference along with the data of our 271 eligible patients. The primary tumor was classified into T1 to T4, and cervical lymph node metastasis was classified into N0 to N2 according to the extent of involvement. Any lesions outside the head and neck were classified as M1. N-NKTCL thereby was classified into four stages: stage I comprised T1-2N0M0; stage II comprised T1-2N1M0 and T3N0M0; stage III comprised T3N1M0, T1-3N2M0, and T4N0-2M0; and stage IV comprised TanyNanyM1. This staging system showed excellent performance in prognosticating survival. In the current series, the 5-year survival rates of patients with stages I, II, III, and IV N-NKTCL were 92%, 64%, 23%, and 0, respectively. Moreover, the predictive value of several currently used factors was abrogated in the presence of the TNM stage. The TNM staging system is highly effective in stratifying tumor burden and survival risk, which may have significant implications in the treatment decision making for patients with N-NKTCL.

Aggressive natural killer (NK)‐cell leukaemia and extranodal NK/T‐cell lymphoma are two distinct diseases that differ in their clinical presentation and cytogenetic findings

“…Although the nasal cavity is the most common site involved, it is not uncommon for involvement of the skin, soft tissue, gastrointestinal tract, testis or even lymph node to be seen . Marrow involvement can occur in 0.4–16% of the cases, which might be similar to what is seen in aggressive NK‐cell leukaemia …”

“…Although the nasal cavity is the most common site involved, it is not uncommon for involvement of the skin, soft tissue, gastrointestinal tract, testis or even lymph node to be seen. 1 Marrow involvement can occur in 0.4-16% of the cases, [2][3][4] which might be similar to what is seen in aggressive NK-cell leukaemia. 1 Hydroa vacciniforme-like lymphoproliferative disorder is a rare cutaneous T-cell or sometimes NK-cell lymphoma of children and adolescents.…”

Linfoma nasal de células T/Natural Killer. Descripción de un caso

“…El diagnóstico diferencial histoló-gico incluye la granulomatosis linfomatoide, linfoma NK blástico, enteropatía asociada a linfocitos T y linfoma hidro-like [8]. Zheng Yan [9], propuso en 2015 un nuevo sistema de clasificación TNM para el linfoma NK nasal, estableciendo de forma más precisa tratamiento y pronóstico, superando limitaciones de la antigua clasificación de Ann Arbor (Tabla 1). Respecto al tratamiento, el LNT/NK es radiosensible, siendo posible lograr un control local de la enfermedad.…”

“…Respecto al tratamiento, el LNT/NK es radiosensible, siendo posible lograr un control local de la enfermedad. Lamentablemente, la recidiva tumoral se describe en la mayoría de series, (hasta el momento no ha sido así en nuestro caso) [8,9]. Existe un consenso sobre la utilización conjunta de RT y QT en estadios avanzados, si bien en fases iniciales la QT no parece aportar mejoría adicional de supervivencia respecto a RT aislada [4,9].…”

Extranodal NK/T-cell lymphoma: a review of literature and case report

“…няемая при солидных опухолях [32]. На основании ретроспективного анализа данных о распространен-ности опухолевого процесса и результатах лечения 271 пациента авторами были выделены 4 стадии.…”