诱导化疗联合同期放化疗与同期放化疗治疗局部晚期鼻咽癌的对比研究

  目的  比较诱导化疗联合同期放化疗与同期放化疗治疗局部晚期鼻咽癌(LA-NPC)的临床结果及探讨预后因素。  方法  分析2005年1月至2006年12月本院收治的433例无转移LA-NPC患者的临床资料, 按是否行诱导化疗分为诱导化疗联合同期放化疗组(A组)209例与同期放化疗组(B组)224例。采用Kaplan-Meier法进行生存分析, 差异比较采用Log-Rank法双侧检验, 预后因素分析采用Cox模型。  结果  A组、B组的3年总生存率(OS)、无局部区域复发生存率(LR-FFS)、无远处转移生存率(D-FFS)、无瘤生存率(FFS)分别为87% vs. 88%、95% vs. 95%、85% vs. 85%、81% vs. 81%;A组、B组的5年OS、LR-FFS、D-FFS、FFS分别为80% vs. 82%(P=0.503), 95% vs. 93%(P=0.673), 82% vs. 82%(P=0.992), 78% vs. 77%(P=0.851)。两组生存差异无统计学意义, 对于Ⅲ期鼻咽癌, A组FFS优于B组(P=0.075)。多因素分析显示老年、临床分期晚、颅神经侵犯、贫血、N分期晚为OS、D-FFS的独立不良预后因素。  结论  与同期放化疗相比, 诱导化疗联合同期放化疗未提高LA-NPC的OS、LR-FFS、D-FFS及FFS, 但具有改善Ⅲ期鼻咽癌FFS的趋势。诱导化疗联合同期放化疗不是鼻咽癌的必选治疗模式。 

Induction chemotherapy combined with concurrent chemoradiotherapy versus simple concomitant chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma

  Objective  This study was aimed to make a comparison between induction chemotherapy followed by concurrent chemoradiotherapy and simple concomitant chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma(LA-NPC). It also aims to investigate prognostic factors.  Methods  Between January 2005 and December 2006, clinical data of 433 cases of non-metastatic LA-NPC undergoing initial treatment were collected and retrospectively analyzed. The patients were divided into Group A(209 cases) and Group B(224 cases). Group A underwent induction chemotherapy with concurrent chemoradiotherapy, whereas Group B underwent concomitant chemoradiotherapy alone. Kaplan-Meier method was employed for survival analysis. Log-rank test was used to analyze the statistical significance in the differences among the survival curves. A multivariate analysis with Cox proportional hazards model was used to test the independent prognostic factors.  Results  This study showed that the three-year overall survival(OS) rates were 87% and 88%, with the locoregional failure-free survival(LR-FFS) rates of 95% and 95%, distant failure-free survival(D-FFS) rates of 85% and 85%, and failure-free survival(FFS) rates of 81% vs. 81% in Groups A and B, respectively. The five-year OS rates were 80% and 82%(P=0.503), with LR-FFS rates of 95% vs. 93%(P=0.673), D-FFS rates of 82% vs. 82%(P=0.992), and FFS rates of 78% vs. 77%(P=0.851) in Groups A and B, respectively. Median follow-up was 61.1 months(ranging from 12.0 months to 75.7 months). No statistical differences were observed in the survivals between the two groups. However, improved FFS rate was observed for stage Ⅲ disease, which favors Group A(P=0.075). Multivariate analysis also showed that old age, advanced clinical stage, cranial nerve involvement, decreased hemoglobin, and advanced N stage were the independent adverse prognostic factors for both OS and D-FFS.  Conclusion  Induction chemotherapy followed by concurrent chemoradiotherapy did not improve OS, LR-FFS, D-FFS, or FFS for LA-NPC, compared with concurrent chemoradiotherapy alone. However, induction chemotherapy followed by concurrent chemoradiotherapy showed a trend of improved FFS for stage Ⅲ disease favoring Group A. Thus, neoadjuvant chemotherapy combined with concomitant chemoradiotherapy is not the necessary choice in managing LA-NPC.