摘要
目的评估鼻咽癌调强放疗的长期疗效，分析影响预后的因素。方法回顾分析299例无远处转移鼻咽癌首程治疗病例资料。鼻咽原发灶及上颈部调强放疗70Gy，下颈部及锁骨上区用单前野预防性常规放疗54Gy，5次／周共30次。鼻咽残存灶采用局部小野IMRT加量或x刀补充照射4～20Gy。用Kaplan—Meier方法计算总生存率（0s）、无疾病进展生存率（DPFS）、无远处转移生存率（DMFS）等，Logrank法检验和单因素预后分析，Cox法多因素预后分析。结果全组随访率为99．7％，随访时间满5年者为119例。Ⅰ＋Ⅱ、Ⅲ、Ⅳ期5年0s分别为97．1％、82．7％、52．2％（X^2=46．19，P=0．000），DPFS分别为100％、77．6％、57．7％（X2=23．29，P=0．000），DMFS分别为100％、82．3％、63．7％（X2=16．57，P=0．000）。男性和女性5年OS、DPFS、DMFS分别为70．7％和94．1％（X2=16．82，P=0．000）、71．5％和87．3％（X2=4．74，P=0．029）、77．2％和89．7％（x2=4．38，P=0．036）；〈45岁男性和女性的分别为66．8％和91．2％（X2=7．07，P=0．008）、59．9％和91．2％（x2=7．72，P=0．005）、66．4％和94．0％（x2=8．46，P=0．004），≥45岁的只有0s不同（72．2％和96．0％，X2=10．19，P=0．001）。多因素分析显示性别、TNM分期、淋巴结包膜受侵均影响OS（X2=14．27、5．72、17．64，P=0．000、0．017、0．000）、DPFS（X2=5．33、15．70、10．57，P=0．021、0．000、0．001）、DMFS（X2=4．30、11．08、犁．24，P=0．038、0．001、0．000），颅内受侵、锁骨上淋巴结转移影响0S（X2=13．32、5．38，P=0．000、0．020）。结论除分期、淋巴结包膜受侵影响预后外，性别也是影响预后因素之一，特别是〈45岁男性预后更差。
Objective To study long-term outcome and prognostic factors of nasopharyngeal carcinoma treated by intensity modulated radiotherapy. Methods A total of 299 patients with non- disseminated nasopharyngeal carcinoma who received initial radiotherapy were analyzed retrospectively. The primary lesion and the upper neck received 70 Gy （5 fraction per week in all 30 fraction） by intensity- modulated radiotherapy （IMRT）. The lower neck and the supraclavicular fossa was given 54 Gy （5 fraction per week in all 30 fraction） by a single anterior tangent field with spinal cord block. A median dose of 9. 2 Gy （4-20. Gy） was given to the residual primary lesion by IMRT or X-knife. The Kaplan-Meier method was used for calculating the overall survival （OS）, disease progression-free survival （DPFS）, distant metastasis- free survival （DMFS） , Log-rank test was used for evaluating the differences between groups. Multivariate prognostic factor was analyzed by Cox method. Results The follow-up rate was 99.7%. 119 patients were followed-up more than with 5 years. The 5-year OS for stage [ ＋ 1I , stage m and stage IV were 97.1%, 82. 7% and 52. 2% （ X2 = 46. 19, P = 0. 000） , the 5 years DPFS were 100% ,77.6% and 57.7% （ X2 = 23.29,P =0. 000） ,DMFS were 100% ,82. 3% ,63.7% （X2 = 16.57,P =0. 000） respectively. The 5 year OS, DPFS and DMFS of male and female were 70.7% vs94.1%（X2=16.82,P=0.000）, 71.5% vs 87.3% （X2 =4. 74,P = 0. 029） and 77. 2% vs 89.7% （X2 = 4.38, P = 0. 036） respectively. For patients who were younger than 45-years, the male had a significantly unfavorable 5-year OS （66. 8% vs. 91.2% , X2=7.07,P=0.008）, DPFS （59.9% vs. 91.2%,X2=7.72,P=0.005） and DMFS （66.4% vs. 94.0% ,X2 =8.46,P =0. 004） ;For patients who were old than 45-years, only OS was significantly different between male and female （72. 2% vs. 96. 0% ,X2 = 10. 19, P = 0. 001 ）. Multivariate analysis showed the independent prognostic factors for OS, DPFS, DMFS, were gender （X2 = 14.2 7,5.7 2,17.6 4, P = 0.0 0 0,0. 017,0. 000） , TNM stage （X2 = 5.33,15.70,10. 57,P = 0. 021,0. 000,0. 001 ） and lymph nodes capsular invasion （ X2= 4. 30,11.08,21.24, P = 0. 038,0. 001,0. 000 ）. Intracranial invasion and supraelavieular lymph node metastasis were independent prognostic factors for OS （ X2 = 13.32,5.38, P = 0. 000,0. 020）. Conclusions The TNM stage, lymph nodes capsular invasion and gender are independent prognostic factors for nasopharyngeal carcinoma treated by intensity-modulated radiotherapy. The patients of younger than 45- years own a worse outcome.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2012年第6期488-491,共4页
Chinese Journal of Radiation Oncology
基金
澳门科技发展基金会资助项目（No.069/2009/A3）
关键词
鼻咽肿瘤
放射疗法
放射疗法
调强
常规
预后
Nasopharyngeal neoplasms/radiotherapy
Radiotherapy, intensity-modulated
Radiotherapy, convention
Prognosis
