基于IMRT和RTOG颈部淋巴结分区标准的鼻咽癌N分期研究

目的 建立一个基于IMRT和RTOG颈部淋巴结分区标准的鼻咽癌新N分期。 方法 回顾分析广西医科大学第一附属医院2010—2011年经病理学证实、无DM并接受IMRT的初治鼻咽癌患者324例,根据鼻咽癌UICC/AJCC分期标准(第7版)进行重新分期。Kaplan-Meier法计算生存率,Logrank法单因素预后分析,Cox模型多因素预后分析。 结果 324例患者中269例(83.0%)出现转移淋巴结,中位随访58个月(6~77个月),全组5年OS率为84.8%,DFS率为77.1%,RFS率为92.7%,DMFS率为80.5%。对其中颈部淋巴结阳性患者预后因素分析显示咽后淋巴结、颈部淋巴结水平、侧数是影响鼻咽癌患者预后因素(P值均<0.05)。根据风险比差异确定鼻咽癌新N分期: N₀期为无淋巴结转移;N₁期为Ⅶ_a区或/和单侧上颈(Ⅰ、Ⅱ、Ⅲ、V_a区)淋巴结转移;N₂期为双侧上颈(Ⅰ、Ⅱ、Ⅲ、Ⅴ_aa区)淋巴结转移;N₃期为Ⅳ _a、Ⅴ_b区及以下区域淋巴结转移。 结论 基于IMRT和RTOG颈部淋巴结分区标准的鼻咽癌新N分期更符合现状,并能更客观预测预后、指导治疗。

Study on N staging system for nasopharyngeal carcinoma based on intensity-modulated radiotherapy and RTOG guidelines for cervical lymph node levels

Objective To propose a new N staging system for nasopharyngeal carcinoma based on intensity-modulated radiotherapy (IMRT) and Radiation Therapy Oncology Group (RTOG) guidelines for cervical lymph node levels.Methods A retrospective analysis was performed in 324 patients with newly diagnosed nasopharyngeal carcinoma who had no distant metastasis confirmed by pathology and received IMRT in the Department of Radiation Oncology in The First Affiliated Hospital of Guangxi Medical University from January 2010 to December 2011.They were restaged according to the 7thedition of UICC/AJCC staging system for nasopharyngeal carcinoma.The survival rates were estimated using the Kaplan-Meier method and the log-rank test was used for univariate prognostic analysis.The Cox proportional hazards model was used for multivariate prognostic analysis.Results Of 324 patients,269(83.0%) had lymph node metastasis.The median follow-up was 58 months (6-77 months).The 5-year overall survival,disease-free survival,relapse-free survival,and distant metastasis-free survival rates were 84.8%,77.1%,92.7%,and 80.5%,respectively.Univariate and multivariate analyses of patients with positive cervical lymph nodes revealed that retropharyngeal lymph node status,cervical lymph node level,and laterality were evaluated as independent prognostic factors for nasopharyngeal carcinoma.According to the hazard ratio calculated,the N staging system was revised as follows:N0:no regional lymph node metastasis;N1:VⅡ a or/and unilateral levels (I,Ⅱ,Ⅲ,Va) involvement;N2:bilateral levels (I,Ⅱ,Ⅲ,Va) involvement;N3:levels IVa,Vb,and IVb+Vc involvement.Conclusions The proposed N staging system is based on IMRT and RTOG guidelines for lymph node levels and more practical,and can provide highly objective prediction of outcome and guide treatment in nasopharyngeal carcinoma.