635例非高发区局部晚期鼻咽癌调强放疗的长期随访观察

目的 探讨江苏省初治局部晚期（Ⅲ、ⅣA、ⅣB期）鼻咽癌患者调强放疗联合化疗治疗后长期生存情况及预后影响因素。方法 收集江苏省肿瘤医院放疗科2009年1月至2013年12月收治的局部晚期鼻咽癌635例进行回顾性分析。所有患者均接受调强放疗，其中604例患者接受了含铂方案为主的化疗。采用Kaplan-Meier法进行生存分析，用Log-rank检验和Cox比例风险回归模型分析局部晚期鼻咽癌患者的预后相关因素。结果 随访5～92个月，中位随访时间63.5个月。全组患者的5年局部无复发生存（LRFS）、 区域无复发生存（RRFS）、无远处转移生存（DMFS）、无进展生存（DFS）、总生存（OS）率分别为88.4％、94.2％、79.2％、71.9％和76.3％。175例（27.6％）治疗失败，其中远处转移（131例，74.9％）是主要的治疗失败形式。T分期是LRFS的独立预后因素，临床分期、N分期和化疗是RRFS、DMFS、DFS及OS的独立预后因素。结论 调强放疗提高了鼻咽癌患者的远期疗效。除了T、N分期是影响预后的重要因素外，化疗对预后也起到一定的作用。

The long-term survival outcomes of 635 patients with locoregionally advanced nasopharyngeal carcinoma treated with intensity-modulated radiation therapy in non endemic area

Objective To evaluate the long-term survival outcomes and prognostic factors of locoregionally advanced (Ⅲ,ⅣA,ⅣB) nasopharyngeal carcinoma( NPC) patients treated with intensity-modulated radiation therapy ( IMRT) plus chemotherapy in Jiangsu Province. Methods From January 2009 to December 2013, 635 locoregionally advanced NPC patients treated by IMRT and platinum-based chemotherapy were analyzed retrospectively. Survival data were calculated with a Kaplan-Meier method. Log-rank test and Cox proportional hazard regression model were performed to investigate the risk factors of prognosis. Results With a median fol-low-up of 63. 5 months ( range 5-92 months ) , the 5-year local recurrence-free survival ( LRFS ) , regional recurrence-free survival ( RRFS) , distant metastasis-free survival ( DMFS ) , disease-free survival ( DFS ) and overall survival ( OS ) rates were 88. 4%, 94. 2%, 79. 2%, 71. 9% and 76. 3%, respectively. Of the 635 patients, 175 ( 27. 6%) developed failure after treatment. Distant me-tastasis ( n=131, 74. 9%) was the major failure pattern after treatment. T stage was an independent prognostic factor for LRFS. N stage, clinical stage and chemotherapy were independent prognostic factors for RRFS, DMFS, DFS and OS. Conclusion IMRT pro-vides satisfactory long-term outcome for NPC. T and N stage are important prognostic factors, as well as chemotherapy.