摘要
目的:研究T3鼻咽癌患者经调强放射治疗(IMRT)后的临床疗效及相关解剖结构的预后价值。方法:研究纳入348例无远处转移经IMRT治疗后的鼻咽癌患者,原发灶根据第7版UICC/AJCC分期系统均为T3,采用Kaplan Meier生存曲线计算5年生存率(OS)、5年无局部复发生存率(LFS)、5年无区域复发生存率(RFS)、5年无远处转移生存率(DMFS)及5年无病生存率(DFS),并对颅底及鼻旁窦等相关解剖结构受累的预后价值进行比较。结果:中位随访时间为65.7个月,5年OS、LFS、RFS、DMFS及DFS分别为90.9%、93.7%、93.9%、83.5%和72.6%。多因素分析显示超过1处颅底骨质或鼻旁窦受累是DMFS和DFS的独立预后因素(P=0.017,P=0.011),尽管在OS方面未达到统计学差异(80.8%vs 91.3%)。此外N分期(N0-1 vs N2-3)是DMFS、DFS及OS的独立预后因素(P=0.002,P<0.001,P<0.001)。结论:IMRT为T3鼻咽癌患者带来良好的局控率,而远处转移仍是主要的失败模式。T3鼻咽癌患者的局部解剖结构受累数量可能存在一定的预后价值,针对可能发生远处转移的高危患者应加强治疗强度。
Objective： To evaluate the effectiveness and analyze the prognostic value factors in T3 classification of nasopharyngeal carcinoma （NPC） after intensity modulated radiotherapy （IMRT）. Methods： A total of 348 non-metastatic NPC patients treated with IMRT were retrospectively reviewed. All the primary tumors were defined as T3 according to the 7th UICC/AJCC staging system. The prognostic significance of different skull base sites and paranasal sinuses involvement were analyzed using Kaplan-Meier method and compared by log-rank tests for 5-year overall survival （OS）, local failure-free survival （LFS）, regional failure- free survival （RFS）, distant metastasis-free survival （DMFS） and disease-free survival （DFS）. Results： With a median follow- up of 65.7 months, the 5-year OS, LFS, RFS, DMFS and DFS for T3 NPC patients were 90.9%, 93.7%, 93.9%, 83.5% and 72.6%. Multivariate analysis showed that 〉2 abnormality sites was an independent prognostic factor for DMFS and DFS （P 0.017, P 0.011）, although it didn＇t achieve statistical significance for 5-year OS （80.8% vs 91.3%）. N stage （N0-1 vs N2-3） was an independent prognostic factor for DMFS, DFS and OS （P 0.002, P〈0.001, P〈0.001）. Conclusion： IMRT provides excellent locoregional control for T3 patients with nasopharyngeal carcinoma. Distant metastasis becomes the predominant pattern of failure. Number of subclassifications involved of T3 NPC patients may have different prognostic values. Treatments should be strengthened for patients with high risk of distant failure.
作者
杨佑琦
胡超苏
YANG You-qi;HU Chao-su(Department of Radiation Oncology,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University（Shanghai 200032)
出处
《中国医疗器械信息》
2018年第16期1-4,共4页
China Medical Device Information
关键词
鼻咽癌
调强放疗
临床疗效
解剖结构
预后价值
nasopharyngeal carcinoma
intensity-modulated radiotherapy
clinical outcomes
subclassification
prognostic value
