淋巴结阳性鼻咽癌患者与IMRT后发生远处转移相关性研究

目的 评价颈部转移性淋巴结与鼻咽癌IMRT后发生远处转移之间关系。方法 回顾分析2010—2012年接受IMRT的474例初治无远处转移鼻咽癌患者资料,采用Kaplan-Meier法计算各种生存率并Logrank检验和单因素预后分析,采用进入法进行Cox模型多因素分析。结果 474例患者中400例发生颈部淋巴结转移,122例经IMRT后存在颈部淋巴结残留。4年累计远处转移率13.7%(65/474),4年OS、DFS、LRFS、DMFS分别为82.9%、81.4%、93.5%、86.3%。单因素及多因素分析显示治疗方式、下颈Ⅳ/Ⅴb/Ⅴc区淋巴结转移、颈部转移淋巴结最大直径、残留淋巴结大小、淋巴结消退时间是DMFS的影响因素(P均<0.05)。结论 放化疗能降低鼻咽癌IMRT后远处转移发生率。颈部淋巴结越大,越容易发生残留,残留淋巴结越大,发生远处转移风险越高。颈部大淋巴结(≥6 cm)、残留淋巴结>1 cm及在放疗3个月后仍有淋巴结残留为鼻咽癌IMRT后DMFS的不利预后因素,需探讨更合理的干预治疗方式。

Relationship between positive lymph nodes and distant metastasis after intensity-modulated radiotherapy in patients with nasopharyngeal carcinoma

Objective To explore the relationship between positive cervical lymph nodes and distant metastasis after intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC). Methods A retrospective analysis was performed on the clinical data of 474 patients who were newly diagnosed with NPC but no distant metastasis and received IMRT from 2010 to 2012. The survival rates were calculated by the Kaplan-Meier method. The log-rank test was used for comparison of survival rates and univariate prognostic analysis. The multivariate analysis was made by the Cox regression model. Results In the 474 patients, 400 had positive cervical lymph nodes and 122 had residual masses in the neck after IMRT. The four-year distant metastasis, overall survival, disease-free survival, local relapse-free survival, and distant metastasis-free survival (DMFS) rates were 13.71%(65/474), 82.9%, 81.4%, 93.5%, and 86.3%, respectively. The univariate and multivariate analyses showed that treatment approach, lymph node metastases in lower neck Ⅳ/Ⅴb/Ⅴc regions, the greatest diameter of the positive cervical lymph nodes, the diameter of residual lymph nodes, and time to lymph node recession were independent prognostic factors for DMFS (all P<0.05). Conclusions Chemoradiotherapy can reduce the distant metastasis rate after IMRT for NPC. The larger the cervical lymph nodes are, the more likely there are residual masses;the larger the residual cervical lymph nodes are, the higher risk of distant metastasis there is. Large cervical lymph nodes (≥6 cm), residual masses larger than 1 cm, and residual masses at 3 months after IMRT are negative prognostic factors for DMFS after IMRT for NPC. Better intervention treatment approaches need to be explored.