171例转移性鼻咽癌患者的化疗疗效和预后因素分析

目的 探讨转移性鼻咽癌的最佳治疗方法.方法 回顾性分析171例资料完整、病理确诊的转移性鼻咽癌患者的临床资料.171例患者分别接受最佳支持治疗(26例)、双药联合化疗(92例)和三药联合化疗(53例).最佳支持治疗是指患者未接受化疗,只接受支持治疗或骨转移疼痛处的姑息性放疗;双药联合化疗是指化疗方案以顺铂(DDP)为基础,联合5-氟尿嘧啶[(5-Fu),FP方案]或紫杉醇[(FIX),TP方案]或多西紫杉醇[(DOC),DP方案];三药联合化疗是指在FP方案的基础卜加用FIX(TFP方案)或DOC(DFP方案).比较3种治疗方法的疗效、生存时间、毒副作用和预后影响因素.结果 三药联合化疗组的有效率(RR)为84.9%,显著高于双药组(52.2%,P=0.000).三药联合化疗组Ⅲ～Ⅳ度骨髓抑制和消化道毒副反应的发生率分别为58.5%和64.2%,显著高于双药组(P=0.000和P=O.017).最佳支持治疗组、双药联合化疗组和三药联合化疗组的中位生存期(MST)分别为4.0、13.2和15.0个月,1年生存率分别为24.0%、64.1%和70.3%.两个化疗组患者的MST较最佳支持治疗组显著延长(P=0.000),但双药联合化疗组的MST和1年生存率,与三药联合化疗组相比,差异无统计学意义(P＞0.05).三药联合化疗组中,采用TFP和DFP方案者的RR和MST的差异均无统计学意义(均P＞0.05).双药联合化疗组中,采用FP、TP和DP方案者的RR和MST差异均无统计学意义(均P＞0.05).KPS评分、疾病进展时间(TTP)和化疗周期数是影响转移性鼻咽癌患者生存的独立预后因素(均P＜0.05).结论 化疗可以延长转移性鼻咽癌患者的生存期.含铂三药联合方案的RR高,但毒性大.FP方案或第三代化疗药物加铂类的双药联合方案仍是转移性鼻咽癌的标准治疗方案.

Analysis of responses and prognostic factors in different chemotherapy regimens for metastatic nasopharyngeal carcinoma: a report of 171 cases

Objective The aim of this study was to compare the results of different combined chemotherapy regimens and to find the best regimen for metastatic nasopharyngeal carcinoma(NPC),and determine its prognostic hetom.Methotis The clinical data of 171 patients with pathologically proven metastatic NPC were retrospectively analyzed.Of them.26 were treated with best support care(BSCgroup),92 with platinum-based reginlell of two drugs(FP group:5-Fu and cisplatin;TP group:paclitaxel and cisplatin:DP group:docetaxel and cisplatin),and 53 with platinum-based regimen of three-drugs(TFP group:FP plus paclitaxel,DFP group:FP plus doxtale).Results The response rate(RR)in the threedrug regimens was significantly higher than that in the two-drug regimen(84.9%vs.52.2%,P=0.000),however,grade Ⅲ～Ⅳ myelosuppression in the three-drug regimen group was also significantly higher than that in the two-drug regimen(58.5%vs.27.2%,P=0.000).Among the groups treated with platinumbased combination regimens of either two drugs or three drugs,no significant differences were observed in RR(P=0.967,P=0.400)or median survival time(MST)(P=0.278,P=0.413).The MST and oneyear survival rate were 4.0 months,13.2 months and 15.0 monks,24.0%,64.1%and 70.3%in the BSC group,two-drug group and three-drag group,respectively.The MST in the chemotherapy group was significantly longer than that in BSC group(P=0.000).Cox multivariate regression analysis showed that Kamovsky performance scores,time to progression or chemotherapy eyeles were independent prognostic factors(P＜0.05).Conclusion Chemotherapy can improve the survival of metastatic NPC.Platinumbased combination regimen with two drugs is still the standard treatment.The combination regimens with three drugs can increase the RR,but no survival benefit can be achieved for its high toxicity.