基于MRI和IMRT的鼻咽癌鼻窦侵犯的预后研究

目的探讨基于MRI和IMRT的鼻咽癌鼻窦侵犯在鼻咽癌分期中的意义。方法 回顾分析2005—2010年基于MRI诊断的接受IMRT的1197例初诊鼻咽癌患者资料。根据AJCC第7版分期重新分期。鼻窦侵犯分为伴有鼻窦侵犯T₃、T₄期。Kaplan-Meier法计算LRFS、DMFS、OS率并Logrank法检验。Cox模型多因素预后分析及T分期各亚组局部复发风险比。结果 鼻窦侵犯率为14.2%。鼻窦侵犯不是影响鼻咽癌OS、LRFS、DMFS的因素(P=0.677、0.485、0.211)。T₂期、伴鼻窦侵犯T₃期及不伴鼻窦侵犯T₃期局部复发风险比接近(HR=1.927、2.030、2.283)。LRFS、OS曲线在T₂期、伴鼻窦侵犯T₃期及不伴鼻窦侵犯T₃期接近(P>0.05),与伴鼻窦侵犯T₄期及不伴鼻窦侵犯T₄期明显分开(P<0.05)。结论 鼻窦侵犯不是IMRT鼻咽癌OS、LRFS和DMFS的预后因素,但伴鼻窦侵犯的T₃期OS、LRFS与T₂、T₃期相似,预后较T₄期好。

The prognostic value of paranasal sinus involvement based on MRI in nasopharyngeal carcinoma treated with intensity-modulated radiotherapy

Objective To identify the prognostic value of paranasal sinus involvement based on magnetic resonance imaging (MRI) findings in the staging of nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT).Methods The clinical data of 1179 patients who were initially diagnosed with NPC by MRI and received IMRT from 2005 to 2010 were analyzed retrospectively,and staging was performed for these patients again according to the American Joint Committee on Cancer (AJCC) staging system.Paranasal sinus involvement was classified into T3 stage with paranasal sinus involvement and T4 stage with paranasal sinus involvement.Overall survival (OS),local relapse-free survival (LRFS),and distant metastasis-free survival (DMFS) were calculated by the Kaplan-Meier method,and the log-rank test was used for survival difference analysis.The Cox regression model was used to investigate the independent prognostic factors and the hazard ratios for local relapse in each T group.Results The rate of paranasal sinus involvement was 14.2％,and paranasal sinus involvement was not an independent prognostic factor for OS,LRFS,or DMFS of NPC patients (P=0.677,0.485,0.211).The patients in T2 stage,T3 stage with paranasal sinuses involvement,and T3 stage without paranasal sinuses involvement had similar hazard ratios for local relapse (HR=1.927,2.030,2.283),and the three groups of patients also had similar LRFS and OS curves (P＞0.05),which were significantly different from those of the patients in T4 stage with paranasal sinus involvement and T4 stage without paranasal sinus involvement (P＜ 0.05).Conclusions Paranasal sinus involvement is not an independent prognostic factor for OS,LRFS,or DMFS in NPC treated with IMRT;however,the patients in T3 stage with paranasal sinus involvement have similar LRFS and OS as those in T2 and T3 stages,and have better prognosis than those in T4 stage.