481例鼻咽癌患者预后及分期研究
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摘要
第一章481例鼻咽癌患者预后及分期研究
目的回顾性分析湘雅医院481例初诊鼻咽癌患者的临床资料及治疗效果、不良反应,并探索其预后因素,并对'92福州分期及6th AJCC分期进行比较,评价两种分期的风险一致性及差异性。
方法收集从2005年1月到2008年12月在本院接受治疗的481例鼻咽癌患者临床资料,分析其临床特征及总生存率、无瘤生存率、无局部复发生存率及无远处转移生存率,按照’92福州分期及6th AJCC分期对所有病例重新进行分期,比较两种分期方式的T分期、N分期、临床分期及其对预后的预测价值。比较两种分期的风险一致性及差异性,进行预后的多因素分析,P<0.05为差异有统计学意义。
结果1)中位随访时间为44个月(10-75个月),4年无局部复发率、无远处转移率、无瘤生存率及总生存率分别为90.4%、75.0%、68.2%、76.0%。相比与’92福州分期,6th AJCC分期中Ⅱ期病例的比例增高,Ⅲ期、Ⅳ期病例的比例降低。从T分期比较来看,总生存曲线以’92福州分期分开相对较好。’92福州分期中,T2与T3组、T3与T4组之间差异无统计学意义,P值分别为0.128和0.473。6th AJCC分期中,T1和T2组、T2与T3组、T3与T4组之间差异无统计学意义,P值分别为0.053、0.071和0.918。’92福州分期中,NO与N1组、N2与N3组之间差异无统计学意义,P值分别为0.931和0.721。6th AJCC分期中,NO与N1组、N2与N3组之间差异无统计学意义,P值分别为0.645和0.578。’92福州分期中,Ⅲ期与Ⅳ期曲线之间差异无统计学意义,P值为0.196。6th AJCC分期中,Ⅲ期与Ⅳ期曲线之间差异无统计学意义,P值为0.281。2)单因素分析表明年龄、有无颈鞘侵犯、有无颅底侵犯、临床分期、T分期、N分期、淋巴结侧数(单/双侧)为影响总生存率的相关因素；颈鞘侵犯、颅底侵犯、颅神经侵犯、临床分期、T分期、N分期、淋巴结侧数为无瘤生存率的相关因素；临床分期、T分期、放疗方式、化疗方式、有无使用增敏剂为无局部复发生存率的相关因素；性别、颈鞘侵犯、颅底侵犯、分期、T分期、N分期为无转移生存率的相关因素(两种分期都有统计学意义,P<0.05)。3)分期因素是影响鼻咽癌最重要的的独立预后因素：T分期和N分期对总生存率、无远处转移生存率及无瘤生存率的影响有统计学意义,T分期和放疗方式对无局部复发率的影响有统计学意义。是否采用调强适形放射治疗技术为局部复发的独立预后因素,调强适形放射治疗组的局部复发的风险较2D—常规放射治疗组低,有统计学差异(P=0.018)。结论T分期和N分期对总生存率、无远处转移生存率及无瘤生存率的影响有统计学意义,T分期和放疗方式对无局部复发率的影响有统计学意义。
第二章鼻咽癌调强适形放疗与常规放疗的疗效及预后因素比较
目的放疗是治疗鼻咽癌的主要手段。本研究对鼻咽癌患者调强适形放疗与常规放疗的疗效及预后因素进行比较。
方法收集2005年1月至2008年12月在我院经病理活检确诊,无远处转移的初治鼻咽癌患者,调强适形放射治疗放疗组182例,常规放射治疗放疗组198例。进行回顾性病例对照研究,比较两组的临床资料、疗效及预后因素。
结果1)调强适形放射治疗组和常规放射治疗组的4年无局部复发率、无转移生存率、无瘤生存率、总生存率分别为93.6%和85.3%、79.1%和73.6%、74.7%和65.0%、83.5%和72.1%。调强适形放射治疗组的4年无局部复发率及总生存率比常规放射治疗组高,而两组的无转移生存率及无瘤生存率无统计学差异。2)调强适形放射治疗组的急性皮肤及口腔粘膜反应、急性唾液腺反应与常规放射治疗组比较差异有统计学意义(P<0.05),而骨髓抑制反应差异无统计学意义(P>0.05)。调强适形放射治疗组发生各种晚期反应的患者比例和严重程度小于常规放射治疗组。3)多因素分析结果表明,常规放射治疗组临床分期或T和N分期与鼻咽癌无瘤生存率、无转移生存率及总生存率显著相关,T分期与鼻咽癌无局部复发率显著相关。而调强适形放射治疗组T分期、N分期与各生存率无显著相关。
结论调强适形放射治疗治疗鼻咽癌相较于常规放射治疗,无局部复发率和总生存率提高,不良反应减轻。进行调强适形放射治疗治疗的鼻咽癌患者,T分期不是各生存率的独立预后因素。为了减少远处转移需采取更有效方法。随着鼻咽癌治疗中调强适形放射治疗应用增加,目前的分期系统面临新的挑战。
1. Prognosis and study of the staging system of481cases with nasopharyngeal carcinoma
Objective This study aims to analyze the outcome and prognostic fact-ors of481cases of nasopharyngeal carcinoma and compare the'92FuZ-hou staging system and6th AJCC staging system.
Methods For this retrospective analysis, the treatment records of481patients newly diagnosed as NPC for the first time from Janurary2005to December2008in our hospital were reviewed. Patients were re-graded in accordance with the'92staging and6th AJCC staging system. We compa-red the risk consistency and difference of the two staging system and analyzed the prognostic factors.
Results1) The4-year local-regional control(LRC),distant metastasis-free survival(DMFS), disease-free survival (DFS), overall survival (OS) of IMRT group and CRT group were90.4%,75.0%68.2%and76.0%, respectively. Compared to92Fuzhou staging, in6th AJCC staging system, the proportion of Ⅱ grade increased, the proportion of Ⅲ and Ⅳ grade decreased. As for T stage, the overall survival curves of '92Fuzhou staging separate relatively better. In '92Fuzhou staging, no significant difference was found between T2and T3group, T3and T4groups respectively(P=0.128and0.473). In6th AJCC staging, T1and T2, T2and T3, T3and T4were not significantly different between respectively (P=0.053,0.071and0.918). In '92Fuzhou staging, No statistically significant differences were found between, NO and N1, N2and N3group (P=0.931and0.721, respectively). In6th AJCC staging, NO and N1, N2and N3group were not statistically difference (P=0.645and0.578, respectively). In '92Fuzhou staging, curves between Ⅲ and Ⅳ grade was of no significant difference (P=0.196). In6th the AJCC stage, curves between Ⅲ and Ⅳ grade was of no significant difference (P=0.281).2) Univariate analysis revealed that that age, the carotid sheath invasion, the skull base invasion, stage, T stage, N stage, lymph node sides were significant prognostic factors with overall survival; skull base invasion,cranial nerve invasion, stage, T stage, N stage, lymph nodes lateral/bilateral were significant prognostic factors with the tumor-free survival; T stage, IMRT/CRT, chemotherapy, with or without sensitizers were relevant factors of local recurrence-free survival;age, skull base invasion, cranial nerve invasion, stage, T stage, N stage, lymph node sides were significant prognostic factors with DMFS (P<0.05).3) Multivariate analysis showed that T stage, lymph nodes of unilateral and bilateral were independent prognostic factors of overall survival (P values of'92Fuzhou stagingwere0.030,0.039, P values of6th AJCC staging were0.030,0.039); T stage, N stage were independent prognostic factors of disease-free survival (P values of'92Fuzhou staging were0.001,0.019, P values of6th AJCC staging were0.000,0.007), while the prognostic factors for overall survival rates were different (P value of'92Fuzhou staging was0.306, P value of6th AJCC staging was0.031); T stage was an independent prognostic factor of no distant metastasis survival (P value of'92Fuzhou staging was0.022, P value of6th AJCC staging was0.034).
Conclusion T stage, N stage were independent prognostic factors for overall survival, disease-free survival and distant metastasis free survival's stage and radio-therapeutic methods were independent prognostic factors for local-regional control.
2. Outcomes and prognostic factors of conformal radiotherapy versus intensity-modulated radiotherapy for nasopharyngeal carcinoma
Objective This study aims to compare outcomes and prognostic factors of nasopharyngeal carcinoma (NPC) treated with conformal radio-therapy (CRT) and with intensity-modulated radiotherapy (IMRT).
Methods For this retrospective analysis, the treatment records of380patients newly diagnosed as NPC for the first time from January2005to December2008in our hospital were reviewed.182cases treated with IMRT,198cases treated with CRT. The clinical characteristics, trea-tment outcomes (including survival analysis and acute, late toxicity) and prognostic factors of two groups were compared.
Results1) The4-year local-regional control(LRC), distant metas-tasis-free survival(DMFS), disease-free survival (DFS), overall survival (OS) of IMRT group and CRT group were93.6%and85.3%,79.1%and73.6%,74.7%and65.0%,83.5%and72.1%,respectively.2) The acute radiation dermatitis and xerostomia of the two groups were significantly different (P<0.05).3) Survival analysis showed that, in IMRT group, OS between different T stages can not be well separated. Multivariate anal-ysis revealed that, in CRT group, the clinical stage or T and N stage were significant prognostic factors for OS、DMFS and DFS, T stage was a significant prognostic factor LRC. In IMRT group, T stage and N stage had no predictive value for outcomes.
Conclusion Compared with CRT, patients treated with IMRT has a better prognosis and less adverse effect. For patients treated with IMRT, T stage was not a significant prognostic factor for LRC, DMFS, DFS or OS. Effective treatment strategy is needed for distant control. With the increasing utilization of IMRT in the treatment of NPC and the continu-ing modulated treatment strategies, current staging system face great cha-llenges.
目的回顾性分析湘雅医院481例初诊鼻咽癌患者的临床资料及治疗效果、不良反应,并探索其预后因素,并对'92福州分期及6th AJCC分期进行比较,评价两种分期的风险一致性及差异性。
方法收集从2005年1月到2008年12月在本院接受治疗的481例鼻咽癌患者临床资料,分析其临床特征及总生存率、无瘤生存率、无局部复发生存率及无远处转移生存率,按照’92福州分期及6th AJCC分期对所有病例重新进行分期,比较两种分期方式的T分期、N分期、临床分期及其对预后的预测价值。比较两种分期的风险一致性及差异性,进行预后的多因素分析,P<0.05为差异有统计学意义。
结果1)中位随访时间为44个月(10-75个月),4年无局部复发率、无远处转移率、无瘤生存率及总生存率分别为90.4%、75.0%、68.2%、76.0%。相比与’92福州分期,6th AJCC分期中Ⅱ期病例的比例增高,Ⅲ期、Ⅳ期病例的比例降低。从T分期比较来看,总生存曲线以’92福州分期分开相对较好。’92福州分期中,T2与T3组、T3与T4组之间差异无统计学意义,P值分别为0.128和0.473。6th AJCC分期中,T1和T2组、T2与T3组、T3与T4组之间差异无统计学意义,P值分别为0.053、0.071和0.918。’92福州分期中,NO与N1组、N2与N3组之间差异无统计学意义,P值分别为0.931和0.721。6th AJCC分期中,NO与N1组、N2与N3组之间差异无统计学意义,P值分别为0.645和0.578。’92福州分期中,Ⅲ期与Ⅳ期曲线之间差异无统计学意义,P值为0.196。6th AJCC分期中,Ⅲ期与Ⅳ期曲线之间差异无统计学意义,P值为0.281。2)单因素分析表明年龄、有无颈鞘侵犯、有无颅底侵犯、临床分期、T分期、N分期、淋巴结侧数(单/双侧)为影响总生存率的相关因素；颈鞘侵犯、颅底侵犯、颅神经侵犯、临床分期、T分期、N分期、淋巴结侧数为无瘤生存率的相关因素；临床分期、T分期、放疗方式、化疗方式、有无使用增敏剂为无局部复发生存率的相关因素；性别、颈鞘侵犯、颅底侵犯、分期、T分期、N分期为无转移生存率的相关因素(两种分期都有统计学意义,P<0.05)。3)分期因素是影响鼻咽癌最重要的的独立预后因素：T分期和N分期对总生存率、无远处转移生存率及无瘤生存率的影响有统计学意义,T分期和放疗方式对无局部复发率的影响有统计学意义。是否采用调强适形放射治疗技术为局部复发的独立预后因素,调强适形放射治疗组的局部复发的风险较2D—常规放射治疗组低,有统计学差异(P=0.018)。结论T分期和N分期对总生存率、无远处转移生存率及无瘤生存率的影响有统计学意义,T分期和放疗方式对无局部复发率的影响有统计学意义。
第二章鼻咽癌调强适形放疗与常规放疗的疗效及预后因素比较
目的放疗是治疗鼻咽癌的主要手段。本研究对鼻咽癌患者调强适形放疗与常规放疗的疗效及预后因素进行比较。
方法收集2005年1月至2008年12月在我院经病理活检确诊,无远处转移的初治鼻咽癌患者,调强适形放射治疗放疗组182例,常规放射治疗放疗组198例。进行回顾性病例对照研究,比较两组的临床资料、疗效及预后因素。
结果1)调强适形放射治疗组和常规放射治疗组的4年无局部复发率、无转移生存率、无瘤生存率、总生存率分别为93.6%和85.3%、79.1%和73.6%、74.7%和65.0%、83.5%和72.1%。调强适形放射治疗组的4年无局部复发率及总生存率比常规放射治疗组高,而两组的无转移生存率及无瘤生存率无统计学差异。2)调强适形放射治疗组的急性皮肤及口腔粘膜反应、急性唾液腺反应与常规放射治疗组比较差异有统计学意义(P<0.05),而骨髓抑制反应差异无统计学意义(P>0.05)。调强适形放射治疗组发生各种晚期反应的患者比例和严重程度小于常规放射治疗组。3)多因素分析结果表明,常规放射治疗组临床分期或T和N分期与鼻咽癌无瘤生存率、无转移生存率及总生存率显著相关,T分期与鼻咽癌无局部复发率显著相关。而调强适形放射治疗组T分期、N分期与各生存率无显著相关。
结论调强适形放射治疗治疗鼻咽癌相较于常规放射治疗,无局部复发率和总生存率提高,不良反应减轻。进行调强适形放射治疗治疗的鼻咽癌患者,T分期不是各生存率的独立预后因素。为了减少远处转移需采取更有效方法。随着鼻咽癌治疗中调强适形放射治疗应用增加,目前的分期系统面临新的挑战。
1. Prognosis and study of the staging system of481cases with nasopharyngeal carcinoma
Objective This study aims to analyze the outcome and prognostic fact-ors of481cases of nasopharyngeal carcinoma and compare the'92FuZ-hou staging system and6th AJCC staging system.
Methods For this retrospective analysis, the treatment records of481patients newly diagnosed as NPC for the first time from Janurary2005to December2008in our hospital were reviewed. Patients were re-graded in accordance with the'92staging and6th AJCC staging system. We compa-red the risk consistency and difference of the two staging system and analyzed the prognostic factors.
Results1) The4-year local-regional control(LRC),distant metastasis-free survival(DMFS), disease-free survival (DFS), overall survival (OS) of IMRT group and CRT group were90.4%,75.0%68.2%and76.0%, respectively. Compared to92Fuzhou staging, in6th AJCC staging system, the proportion of Ⅱ grade increased, the proportion of Ⅲ and Ⅳ grade decreased. As for T stage, the overall survival curves of '92Fuzhou staging separate relatively better. In '92Fuzhou staging, no significant difference was found between T2and T3group, T3and T4groups respectively(P=0.128and0.473). In6th AJCC staging, T1and T2, T2and T3, T3and T4were not significantly different between respectively (P=0.053,0.071and0.918). In '92Fuzhou staging, No statistically significant differences were found between, NO and N1, N2and N3group (P=0.931and0.721, respectively). In6th AJCC staging, NO and N1, N2and N3group were not statistically difference (P=0.645and0.578, respectively). In '92Fuzhou staging, curves between Ⅲ and Ⅳ grade was of no significant difference (P=0.196). In6th the AJCC stage, curves between Ⅲ and Ⅳ grade was of no significant difference (P=0.281).2) Univariate analysis revealed that that age, the carotid sheath invasion, the skull base invasion, stage, T stage, N stage, lymph node sides were significant prognostic factors with overall survival; skull base invasion,cranial nerve invasion, stage, T stage, N stage, lymph nodes lateral/bilateral were significant prognostic factors with the tumor-free survival; T stage, IMRT/CRT, chemotherapy, with or without sensitizers were relevant factors of local recurrence-free survival;age, skull base invasion, cranial nerve invasion, stage, T stage, N stage, lymph node sides were significant prognostic factors with DMFS (P<0.05).3) Multivariate analysis showed that T stage, lymph nodes of unilateral and bilateral were independent prognostic factors of overall survival (P values of'92Fuzhou stagingwere0.030,0.039, P values of6th AJCC staging were0.030,0.039); T stage, N stage were independent prognostic factors of disease-free survival (P values of'92Fuzhou staging were0.001,0.019, P values of6th AJCC staging were0.000,0.007), while the prognostic factors for overall survival rates were different (P value of'92Fuzhou staging was0.306, P value of6th AJCC staging was0.031); T stage was an independent prognostic factor of no distant metastasis survival (P value of'92Fuzhou staging was0.022, P value of6th AJCC staging was0.034).
Conclusion T stage, N stage were independent prognostic factors for overall survival, disease-free survival and distant metastasis free survival's stage and radio-therapeutic methods were independent prognostic factors for local-regional control.
2. Outcomes and prognostic factors of conformal radiotherapy versus intensity-modulated radiotherapy for nasopharyngeal carcinoma
Objective This study aims to compare outcomes and prognostic factors of nasopharyngeal carcinoma (NPC) treated with conformal radio-therapy (CRT) and with intensity-modulated radiotherapy (IMRT).
Methods For this retrospective analysis, the treatment records of380patients newly diagnosed as NPC for the first time from January2005to December2008in our hospital were reviewed.182cases treated with IMRT,198cases treated with CRT. The clinical characteristics, trea-tment outcomes (including survival analysis and acute, late toxicity) and prognostic factors of two groups were compared.
Results1) The4-year local-regional control(LRC), distant metas-tasis-free survival(DMFS), disease-free survival (DFS), overall survival (OS) of IMRT group and CRT group were93.6%and85.3%,79.1%and73.6%,74.7%and65.0%,83.5%and72.1%,respectively.2) The acute radiation dermatitis and xerostomia of the two groups were significantly different (P<0.05).3) Survival analysis showed that, in IMRT group, OS between different T stages can not be well separated. Multivariate anal-ysis revealed that, in CRT group, the clinical stage or T and N stage were significant prognostic factors for OS、DMFS and DFS, T stage was a significant prognostic factor LRC. In IMRT group, T stage and N stage had no predictive value for outcomes.
Conclusion Compared with CRT, patients treated with IMRT has a better prognosis and less adverse effect. For patients treated with IMRT, T stage was not a significant prognostic factor for LRC, DMFS, DFS or OS. Effective treatment strategy is needed for distant control. With the increasing utilization of IMRT in the treatment of NPC and the continu-ing modulated treatment strategies, current staging system face great cha-llenges.
引文
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