精确放疗时代T1期鼻咽癌不同N/M分期的预后分析

目的 探讨精确放疗时代T1期伴不同颈淋巴结转移状态的鼻咽癌患者生存预后,为优化治疗方案提供参考。方法 回顾性分析复旦大学附属眼耳鼻喉科医院放疗科2014—2019年间进行单纯放疗或放化疗的413例局部早期鼻咽癌患者(T1N0-3M0-1期)资料。Kaplan-Meier法生存分析并log-rank法检验。结果 全部病例中男291例、女122例,中位年龄51岁(9~78岁)。病理类型均为鼻咽非角化性癌、未分化型。T1N0M0期(Ⅰ期)48例(11.6%),T1N1M0期(Ⅱ期)158例(38.3%),T1N2M0期(Ⅲ期)162例(39.2%),T1N3M0/T1NxM1期(ⅣA-ⅣB期)45例(10.9%);初治发生转移的ⅣB期患者8例(1.9%)。所有患者总体淋巴结转移率高达88.1%。接受三维适形放疗7例,调强放疗371例,容积调强弧形治疗35例。5年总生存率为(95.9±1.2)%,其中T1N0M0期为100%,T1N1M0期为(99.2±0.8)%,T1N2M0期为(95.1±2.2)%,T1N3M0期为(87.9±6.6)%;初治转移及N3期与患者远期预后显著相关(P<0.05)。放疗远期不良反应中口干不适最常见,发生率为18.6%,其中17.9%为1级不良反应;其次为听觉损伤及牙齿不适等;仅2例发生3级不良反应,表现为听力完全丧失。结论 T1期鼻咽癌患者虽颈淋巴结转移率高,但放疗效果好,精确放疗技术下远期放疗不良反应并未对患者的生存质量产生严重影响。

Prognosis analysis of T1 stage nasopharyngeal cancer with different lymph node and metastasis stages in the era of precision radiotherapy

Objective To evaluate the survival prognosis for T1 stage nasopharyngeal carcinoma patients complicated with different stages of cervical lymph node metastasis, aiming to provide reference for optimizing the treatment plan. Methods Clinical data of 413 patients in non-keratinizing carcinoma and undifferentiated locally early nasopharyngeal carcinoma (T1N0-3M0-1) undergoing radiotherapy alone or radiochemotherapy in Department of Radiation Oncology of our hospital from January 2014 to December 2019 were retrospectively analyzed. The survival analyses were performed with Kaplan-Meier method and statistically compared using the log-rank test. Results Of all patients, 291 were male, and 122 were female (aged from 9 to 78 years old) with a median age of 51 years old. All patients were diagnosed with T1N0-3M0-1 nasopharyngeal carcinoma. In the TNM stage grouping system, 48(11.6%) patients were classified as stage Ⅰ (T1N0M0), 158(38.2%) cases of stage Ⅱ(T1N1M0), 162(39.2%) cases of stage Ⅲ(T1N2M0), and 45(10.9%) cases of stage ⅣA to ⅣB(T1N3M0/T1NxM1). Eight patients (1.9%) with stage ⅣB had metastasis at presentation. The lymph node positivity rate of all patients reached up to 88.1%. Seven patients received three-dimensional conformal radiotherapy, 371 cases of intensity-modulated radiotherapy and 35 cases of volumetric-modulated arc therapy. The 5-year overall survival rate was (95.9±1.2)% and with 100% for T1N0M0 patients,(99.2±0.8)% for T1N1M0 patients,(95.1±2.2)% for T1N2M0 patients and (87.9±6.6)% for T1N3M0 patients, respectively. Primary distant metastasis and N3 stage were significantly correlated with poor prognosis (both P<0.05). The most common long-term side effect of radiotherapy was xerostomia with an incidence rate of 18.6%(17.9% for grade 1 toxicity), followed by hearing damage and tooth discomfort. Only 2 patients developed Grade Ⅲ toxic reactions, manifested as complete hearing loss. Conclusions Although T1 nasopharyngeal carcinoma patients have a high propensity of cervical node metastasis, favorable clinical prognosis can be obtained after radiotherapy alone. Moreover, the long-term side effects under precision radiation exert no severe effect upon the quality of life of patients.