血清淀粉样蛋白A升高与局部晚期鼻咽癌预后的倾向匹配研究

目的 探讨血清淀粉样蛋白A(serum amyloid A,SAA)升高对局部晚期鼻咽癌患者预后的影响。 方法 分析2012年11月5日—2015年3月5日郑州大学第一附属医院收治的315例接受放化疗的Ⅲ~ⅣA/B期鼻咽癌患者临床及随访资料,SAA升高者53例(SAA-H),依据性别、年龄、KPS评分、T分期、N分期、临床分期采用倾向值匹配法,获得106例(1∶2匹配)SAA正常者(SAA-N)。Kaplan-Meier法计算生存率,Cox回归模型进行预后因素分析。主要研究终点:总生存率(OS);次要研究终点:无局部-区域进展生存率(loco-regional relapse-free survival,LRRFS)和无远处转移生存率(distant metastasis-free survival,DMFS)。 结果 315例局部晚期患者中,SAA升高与SAA正常组相比,4年OS为66.0%vs. 82.1%,P=0.007;4年LRRFS为86.8%vs. 90.1%,P=0.385;4年DMFS为58.5%vs. 77.5%,P=0.001。用倾向值匹配法纳入的159例患者中,SAA-H组预后明显差于SAA-N组,4年OS:66.0%vs. 80.2%,P=0.044;4年LRRFS为86.8%vs. 92.5%,P=0.198;4年DMFS为58.5%vs. 74.5%,P=0.023。Cox回归模型显示SAA升高是OS和DMFS的不良预后因素。 结论 SAA升高是局部晚期鼻咽癌患者死亡和转移的预后因素,治疗前SAA水平结合TNM分期可为局部晚期鼻咽癌患者危险度分级,指导临床治疗强度的选择。 

A propensity-matched study of the relationship between elevated serum amyloid A and prognosis of locally advanced nasopharyngeal carcinoma

Objective To investigate the effect of elevated serum amyloid A(SAA) on the prognosis of patients with locally advanced nasopharyngeal carcinoma(NPC). Methods The clinical and follow-up data of 315 patients with staged Ⅲ-ⅣA/B NPC was analyzed. Fifty-three patients with elevated SAA were enrolled in the SAA-H group. According to sex, age, KPS score, T stage, N stage and clinical stage, 106 normal SAA patients(SAA-N) were obtained by the propensity matching method. Kaplan-Meier method was used to calculate survival rate and Cox regression model was used to analyze prognostic factors. The primary endpoints was overall survival(OS), and the secondary endpoints were no loco-regional relapse-free survival(LRRFS) and distant metastasis-free survival(DMFS). Results Of the 315 patients with local advanced NPC, the 4-years OS of SAA-H group was 66.0% vs. 82.1% compared to SAA-N group(P=0.007); the 4-years LRRFS of SAA-H group was 86.8% vs. 90.1% compared to SAA-N group(P=0.385); the 4-years DMFS of SAA-H group was 58.5% vs 77.5% compared to SAA-N group(P=0.001). Among the 159 patients enrolled by the propensity-matching method, the prognosis was significantly worse in the SAA-H group than in the SAA-N group, 4-years OS: 66.0% vs. 80.2%(P=0.044); 4-years LRFSS 86.8% vs. 92.5%(P=0.198); 4-years DMFS 58.5% vs. 74.5%(P=0.023). Cox regression model showed that elevated SAA was an adverse prognostic factor for OS and DMFS. Conclusion The elevated SAA is a prognostic factor for death and metastasis in patients with locally advanced NPC. Pre-treatment SAA levels combined with TNM staging can be used to classify patients and to guide the choice of clinical treatment intensity.