鼻咽癌调强放疗长期疗效及预后分析

目的 评估鼻咽癌调强放疗的长期疗效,分析影响预后的因素。方法 回顾分析 299例无远处转移鼻咽癌首程治疗病例资料。鼻咽原发灶及上颈部调强放疗70 Gy,下颈部及锁骨上区用单前野预防性常规放疗54 Gy,5 次/周共30次。鼻咽残存灶采用局部小野IMRT加量或X刀补充照射 4~20 Gy。用Kaplan-Meier方法计算总生存率(OS)、无疾病进展生存率(DPFS)、无远处转移生存率(DMFS)等,Logrank法检验和单因素预后分析,Cox法多因素预后分析。结果 全组随访率为99.7%,随访时间满 5年者为 119例。Ⅰ+Ⅱ、Ⅲ、Ⅳ期 5年OS分别为97.1%、82.7%、52.2%(χ²=46.19,P=0.000),DPFS分别为100%、77.6%、57.7%(χ²=23.29,P=0.000),DMFS分别为100%、82.3%、63.7%(χ²=16.57,P=0.000)。男性和女性 5年OS、DPFS、DMFS分别为70.7%和94.1%(χ²=16.82,P=0.000)、71.5%和87.3%(χ²=4.74,P=0.029)、77.2%和89.7%(χ²=4.38,P=0.036);<45岁男性和女性的分别为66.8%和91.2%(χ²=7.07,P=0.008)、59.9%和91.2%(χ²=7.72,P=0.005)、66.4%和94.0%(χ²=8.46,P=0.004),≥45岁的只有OS不同(72.2%和96.0%,χ²=10.19,P=0.001)。多因素分析显示性别、TNM分期、淋巴结包膜受侵均影响OS (χ²=14.27、5.72、17.64,P=0.000、0.017、0.000)、DPFS (χ²=5.33、15.70、10.57,P=0.021、0.000、0.001)、DMFS (χ²=4.30、11.08、21.24,P=0.038、0.001、0.000),颅内受侵、锁骨上淋巴结转移影响OS (χ²=13.32、5.38,P=0.000、0.020)。结论 除分期、淋巴结包膜受侵影响预后外,性别也是影响预后因素之一,特别是<45岁男性预后更差。

long-term outcome and prognostic factors of nasopharyngeal carcinoma treated by intensity modulated radiotherapy

Objective To study long-term outcome and prognostic factors of nasopharyngeal carcinoma treated by intensity modulated radiotherapy. Methods A total of 299 patients with non-disseminated nasopharyngeal carcinoma who received initial radiotherapy were analyzed retrospectively. The primary lesion and the upper neck received 70 Gy (5 fraction per week in all 30 fraction) by intensity-modulated radiotherapy (IMRT). The lower neck and the supraclavicular fossa was given 54 Gy (5 fraction per week in all 30 fraction) by a single anterior tangent field with spinal cord block. A median dose of 9.2 Gy (4-20. Gy) was given to the residual primary lesion by IMRT or X-knife. The Kaplan-Meier method was used for calculating the overall survival (OS), disease progression-free survival (DPFS), distant metastasis-free survival (DMFS), Log-rank test was used for evaluating the differences between groups. Multivariate prognostic factor was analyzed by Cox method. Results The follow-up rate was 99.7%. 119 patients were followed-up more than with 5 years. The 5-year OS for stage Ⅰ+Ⅱ, stage Ⅲ and stage Ⅳ were 97.1%,82.7% and 52.2%(χ²=46.19,P=0.000), the 5 years DPFS were 100%,77.6% and 57.7%(χ²=23.29,P=0.000),DMFS were 100%,82.3%,63.7%(χ²=16.57,P=0.000) respectively. The 5 year OS, DPFS and DMFS of male and female were 70.7% vs 94.1%(χ²=16.82,P=0.000), 71.5% vs 87.3%(χ²=4.74,P=0.029) and 77.2% vs 89.7%(χ²=4.38,P=0.036) respectively. For patients who were younger than 45-years, the male had a significantly unfavorable 5-year OS (66.8% vs. 91.2%,χ²=7.07,P=0.008), DPFS (59.9% vs. 91.2%,χ²=7.72,P=0.005) and DMFS (66.4% vs. 94.0%,χ²=8.46,P=0.004);For patients who were old than 45-years, only OS was significantly different between male and female (72.2% vs. 96.0%,χ²=10.19, P=0.001). Multivariate analysis showed theindependent prognostic factors for OS, DPFS, DMFS, were gender (χ²=14.27,5.72,17.64,P=0.000, 0.017,0.000), TNM stage (χ²=5.33,15.70,10.57,P=0.021,0.000,0.001) and lymph nodes capsular invasion (χ²=4.30,11.08,21.24,P=0.038,0.001,0.000). Intracranial invasion and supraclavicular lymph node metastasis were independent prognostic factors for OS (χ²=13.32,5.38,P=0.000,0.020). Conclusions The TNM stage, lymph nodes capsular invasion and gender are independent prognostic factors for nasopharyngeal carcinoma treated by intensity-modulated radiotherapy. The patients of younger than 45-years own a worse outcome.