非高发地区初诊远处转移鼻咽癌患者生存及预后的单中心分析

  目的  分析非高发地区初治远处转移鼻咽癌患者的生存情况及预后因素。  方法  回顾性分析2008年6月至2015年12月四川省肿瘤医院收治的91例初诊远处转移鼻咽癌患者，所有患者均接受原发灶的根治性放疗，放疗剂量为66.0~76.6 Gy（中位剂量71.0 Gy）。87例患者采用以铂类为基础的化疗方案（1~7个周期），未行化疗4例，放疗期间同步靶向治疗17例（尼妥珠单抗或西妥昔单抗）。初治时完成转移灶的局部治疗49例（放疗48例，孤立肺转移手术1例）。患者治疗结束后每3个月随访1次。采用KaplanMeier法计算生存率，采用Cox回归模型进行多因素分析。  结果  中位随访时间41个月。患者1、2、3年生存率分别为83.4%、58.6%、43.3%，中位生存期为32（6~87）个月。转移灶数目>3个（P=0.020）及转移灶无局部治疗（P=0.034）是患者总生存预后不良的独立影响因素。  结论  对于初诊远处转移鼻咽癌，予原发灶根治性放疗（≥66.0 Gy）剂量联合转移灶局部治疗可以改善患者生存率。 

Survival and prognosis of patients with newly diagnosed distant metastatic nasopharyngeal carcinoma in non-endemic areas:a single-center analysis

Objective:To analyze survival and prognostic factors in patients with distant metastatic nasopharyngeal carcinoma in nonendemic areas.Methods:We retrospectively analyzed 91 patients who were newly diagnosed with distant metastatic nasopharyngeal carcinoma from June 2008 to December 2015.All patients received radical radiotherapy targeting the primary foci at a dose of 66-76.6 Gy(median dose 71 Gy).Eighty-seven patients received platinum-based chemotherapy(1-7 cycles),4 patients did not receive chemotherapy,and 17 received concurrent targeted therapy(rituximab or cetuximab)during radiotherapy.Forty-nine patients completed the local treatment for metastatic foci during the initial treatment(48 patients were treated with radiotherapy and 1 patient with isolated lung metastasis was treated with surgery).Patients were followed up every 3 months post-treatment.The Kaplan-Meier method was used to calculate the survival rate,and a Cox regression model was used for multivariate analysis.Results:The median follow-up duration was 41 months.The 1-,2-,and 3-year survival rates were 83.4%,58.6%,and 43.3%,respectively,and the median survival time was 32(6-87)months.The presence of metastases>3(P=0.02)and the absence of local treatment for metastases(P=0.034)were independent factors for poor overall survival and prognosis.Conclusions:In patients with newly diagnosed distant metastatic nasopharyngeal carcinoma,radical radiotherapy(≥66 Gy)targeting the primary foci combined with local treatment of metastatic foci can improve the survival rate.