鼻咽癌调强放疗后长期生存结果及失败模式分析

目的 回顾分析IMRT治疗鼻咽癌的10年生存结果及失败模式,为鼻咽癌的优化治疗提供参考。方法 收集2001-2008年间865例采用IMRT的鼻咽癌患者的临床资料。生存分析采用Kaplan-Meier法,Logrank检验和单因素分析,Cox模型多因素预后分析。结果 中位随访时间为132.0个月,全组患者10年无局部复发生存(LRFS)、无远处转移生存(DMFS)、无进展生存(PFS)、肿瘤特异生存(DSS)分别为92.0%、83.4%、75.7%、78.6%。共210例死亡,其中124例(124/210,59.0%)死于远处转移, 47例(41/210,22.3%)死于局部区域复发。DSS的独立不良预后因素包括年龄>50岁(P=0.00)、LDH≥245 IU/L (P=0.00)、Hb<120 g/L (P=0.01)、T2-T4期(P=0.00)、N1-N3期(P=0.00)和GTV-nx>20 cm³(P=0.00)。Ⅱ期鼻咽癌患者单纯放疗组与联合化疗组10年LRFS、DMFS、DSS均相近(P=0.83、0.22、0.23),Ⅲ期鼻咽癌患者联合化疗组10年LRFS、DSS均优于单纯放疗组(P=0.01、0.01)但10年DMFS相近(P=0.14),Ⅳ a+Ⅳ b期患者总体预后较差。结论 IMRT改善了鼻咽癌患者的远期生存,远处转移成为最主要的失败模式;而Ⅰ-Ⅱ期患者采用单纯IMRT可取得满意生存结果,联合化疗可进一步提高Ⅲ期患者LRFS及DSS,而Ⅳ a+Ⅳ b期患者治疗模式仍需更多探讨。

Long-term survival outcome and failure pattern after intensity-modulated radiotherapy for nasopharyngeal carcinoma

Objective To analyze the 10-year survival outcome and failure patterns for patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT),aiming to provide reference for optimized treatment for NPC. Methods Clinical data of 866 patients with NPC receiving IMRT from January 2001 to December 2008 were retrospectively analyzed. Survival analysis was performed using the Kaplan-Meier estimator. Univariate analysis was carried out by log-rank test and multivariate analysis was performed using Cox proportional hazards model. Results The median follow-up time was 132 months. The 10-year local recurrence-free survival (LRFS),distant metastasis-free survival (DMFS),progression-free survival (PFS) and disease specific survival (DSS) were 92.0%,83.4%,75.7% and 78.6%,respectively. A total of 210 patients died including 124 patients (59.0%) from distant metastasis,which was the primary cause of death,and 47(22.3%) from local regional recurrence. Independent negative factors of DSS included age>50 years (P=0.00),LDH≥245 IU/L (P=0.00),Hb<120 g/L (P=0.01),T2-T4 staging (P=0.00),N1-N3 staging (P=0.00) and GTV-nx>20 cm³(P=0.00).The 10-year LRFS,DMFS and DSS of stage Ⅱ NPC patients did not significantly differ after IMRT alone and chemoradiotherapy (P=0.83,0.22,0.23).For patients with stage Ⅲ NPC,the 10-year LRFS and DSS in the chemoradiotherapy arm were significantly higher than those in the IMRT alone (P=0.01,0.01),whereas no statistical significance was observed in the DMFS between two groups (P=0.14).The overall survival of stage Ⅳ a+Ⅳ b NPC patients is relatively poor. Conclusions IMRT can improve the long-term survival of NPC patients. Distant metastasis is the primary failure pattern. Patients with stage Ⅰ-Ⅱ NPC can obtain satisfactory survival outcomes after IMRT alone. The addition of chemotherapy can further enhance the LRFS and DSS of stage Ⅲ NPC patients. However,the optimal therapeutic strategy remains to be urgently investigated for stage Ⅳ a+Ⅳ b NPC patients.