Novel and simple prognostic index for nasal natural killer/T-cell lymphoma.

BACKGROUND: Few studies have investigated the prognostic factors for nasal natural killer (NK)/T-cell lymphoma. METHODS: This was a retrospective multicenter clinical study. The clinical records of 36 patients with nasal NK/T-cell lymphoma who had been first treated between 1996 and 2011 were collected from 12 hospitals. RESULTS: High serum levels of C-reactive protein (≥1.0 mg/dL), lactate dehydrogenase (≥350 IU/L), and soluble interleukin-2 receptor (sIL-2R; ≥600 U/mL) were associated with worse prognosis. A prognostic score was devised by totaling the number of these 3 predictors: 0 or 1 = score 0; and 2 or 3 = score 1. As for tumor invasion, local invasion beyond the nasal cavity was associated with poor prognosis, and a prognostic score was devised as: tumor restricted to nasal cavity, yes = score 0; no = score 1. A novel prognostic index (NPI) was established based on these scores from 0 to 2. Disease-specific survival rates at 5 years were: 90.0% for NPI = 0; 29.3% for NPI = 1; and 0.0% for NPI = 2. CONCLUSION: Our NPI is valid for anticipating prognosis of nasal NK/T-cell lymphoma.

[Head and neck cancer treatment in the elderly--evaluation and management of complications].

With the population over age 70 growing, treatment for head and neck cancer in the elderly has increased. We retrospectively evaluated their management and outcome. Subjects numbered 121--83 men and 38 women from 70 to 94 years old--initially treated at our hospital. We classified them into 2 groups by age--the aged at 70-79 years (55 men and 26 women) and the very old at 80 years and older (28 men and 12 women). We also evaluated a younger control group aged 50-59 years (37 men and 19 women). Primary tumor sites were the oral cavity (28.1%), larynx (28.1%), paranasal sinus (15.8%), and hypopharynx (9.9%). Preoperative geriatric disease was seen in 54% of controls, 74% of the aged, and 93% of the very old. Cardiovascular and respiratory diseases were most common. Surgical treatment and irradiation were essential for cancer treatment. Postoperative complications, including pneumonia, delirium, renal and cardiovascular hypofunction occurred in 56.5% of controls, 48.2% of the aged, and 47.8% of the very old. The frequency of postoperative complications correlated significantly with the American Society of Anesthesiologist classification of physical status (ASA) and preoperative performance status (PS). The complications of irradiation including pneumonia, dehydration, and feeding disturbance occurred in 53% of the very old. Cures were achieved in 83.9% of controls, 81.5% of the aged, and 65.0% of the very old. Cause specific 5-year survival in those cured was 85.2% of controls, 84.5% of the aged, and 80.0% of the very old. Median survival in those not cured was 4 months in controls, 9.6 months in the aged, and 5 months in the very old. We concluded that curative treatment is important in the elderly, and the success of curative treatment and the prevention of complications depend on careful assessment of systemic disease, PS, ASA, and mental activity.