Prognostic indicators of survival in sinonasal extranodal natural killer/T‐cell lymphoma

Abstract

Objectives Extranodal natural killer/T‐cell lymphoma (ENKTL) is a highly aggressive tumor of the sinonasal tract associated with poor overall survival (OS). This study expands upon epidemiologic, prognostic, and treatment factors for OS and disease‐specific survival (DSS), incorporating newly accessible chemotherapy data. Methods Retrospective population‐based cohort study performed on cases of sinonasal ENKTL identified through the Surveillance, Epidemiology, and End Results database. Univariate Kaplan‐Meier analysis and subsequent multivariate Cox‐regression analysis were performed to evaluate prognostic and treatment variables for OS and DSS. Results Four hundred and sixty cases of sinonasal ENKTL were identified. Five‐year OS and DSS were 46% and 56%, respectively. On multivariate analysis, higher Ann Arbor stage was associated with worse OS (P < 0.001) and DSS (P < 0.001), whereas administration of radiotherapy was associated with improved OS (P < 0.001) and DSS (P = 0.001). Additionally, a higher age at diagnosis was associated with reduced OS (P = 0.024). Chemotherapy was associated with improved OS (P < .01) and DSS (P = .04) for Ann Arbor stage I disease. Surgery was not associated with improved survival. Conclusion This represents the first study to investigate the use of chemotherapy for the treatment of sinonasal ENKTL using population‐based analysis. Radiation therapy and chemotherapy significantly improve survival in all Ann Arbor stage patients and early‐stage patients, respectively. Early‐stage disease is significantly associated with improved survival. With no established treatment regimen for sinonasal ENKTL, these findings suggest combination chemoradiation is an effective therapy for prolonged survival, especially in early stages of disease. Level of Evidence 3 Laryngoscope, 129:2675–2680, 2019

Differential diagnosis of sinonasal extranodal NK/T cell lymphoma and diffuse large B cell lymphoma on MRI

“…The sinonasal ENKTL is generally a highly aggressive tumor characterized by vascular damage and destruction [7]. The prognosis of ENKTL is very poor, with 5-year disease-specific survival of about 31~46% [6,17]. On the other hand, DLBCL has a better prognosis regardless of gender, stage, and age.…”

Cross-sectional imaging evaluation of atypical and uncommon extra-nodal head and neck Non-Hodgkin lymphoma: Case series

“…Given the wide variety in clinical and radiologic presentations of head and neck lymphomas, it should be virtually excluded in any patients presented with nodal or extranodal mass in the head and neck region. [ 2 , 11 , 15 , 16 ] Knowledge of predisposing factors and various radiological signs helps to suggest ENHL of the head and neck and thus leads to biopsy confirmation, initiation of treatment at an early stage, and thus improved patients’ outcome.…”

Sinonasal lymphoma: A primer for otolaryngologists

“…There is a 3:1 male: female predominance and presentation occurs in the fifth and sixth decades of life 35,48,49 . Overall prognosis is poor with reported 1‐, 5‐, and 10‐year OS of 68.6%, 53.2%, and 45.9%, respectively, with a median OS time of 6.73 years 32,41,50–52 . SN‐ENKTL cases are uniformly positive for Epstein–Barr virus (EBV), suggesting its role in SN‐ENKTL pathogenesis 53–56 .…”

“… 35 , 48 , 49 Overall prognosis is poor with reported 1‐, 5‐, and 10‐year OS of 68.6%, 53.2%, and 45.9%, respectively, with a median OS time of 6.73 years. 32 , 41 , 50 , 51 , 52 SN‐ENKTL cases are uniformly positive for Epstein–Barr virus (EBV), suggesting its role in SN‐ENKTL pathogenesis. 53 , 54 , 55 , 56 EBV may also play a role in some cases of SN‐DLBCL.…”