调强放疗技术对鼻咽癌UICC/AJCC分期的影响

目的 探讨调强放疗(IMRT)技术的应用对鼻咽癌第六版UICC/AJCC分期系统的影响.方法 回顾分析2001-2007年间在本院接受IMRT的570例初诊鼻咽癌患者资料,比较不同T分期、N分期以及临床分期之间生存率的差异.结果 全组随访2～94个月,中位值42个月;随访满5年者为184例.全组5年局部无复发生存率、无远处转移生存率和总生存率分别为93.0%、85.4%和83.3%.T分期中T_1、T_(2a)与T_(2b)期间5年局部无复发生存率(100%、100%、94.5%)差异无统计学意义(χ~2=1.92,P=0.166;χ~2:035,P=0.555),T_(2b)与T_3、T_3和T_4期的差异亦无统计学意义(χ~2=2.62,P=0.106;χ~2=1.55,P=0.214).N分期中N_2与N_1、N_3期5年无远处转移生存率(80.2%、86.2%、61.4%)差异无统计学意义(χ~2=2.22,P=0.136;χ~2=1.92,P=0.165).临床分期中Ⅰ、Ⅱ_a、Ⅱ_b期间的5年总生存率(91.7%、100%、95.3%)差异无统计学意义(χ~2:0.32,P=0.574;χ~2=0.25,P=0.617),Ⅳ_a和Ⅳ_b期的差异亦无统计学意义(χ~2=0.25,P=0.616).结论 采用IMRT技术治疗鼻咽癌患者,目前的鼻咽癌第六版UICC/AJCC分期系统存在不同期别5年生存率差异不明显的现象.

Impact of intensity-modulated radiotherapy on the 6th edition of UICC/AJCC staging system in nasopharyngeal carcinoma

Objective To re-evaluate the prognostic value of the 6th edition of UICC/AJCC staging system in patients with nasopharyngeal carcinoma (NPC) treated with intensity-medulated radiation therapy (IMRT). Methods From February 2001 to March 2007, Clinical data of 570 NPC patients initially treated with IMRT in Cancer Center of Sun yat-sen University were reviewed and the long-term survival was analyzed according to T, N and overall stages. Results The median follow-up was 42 months. 184 patients were followed up to 5 years. The 5-year local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS) and overall survival (OS) of the whole group were 93. 0%, 85.4% and 83. 3% ,respectively. No statistically significant difference of LRFS was detected between the either two of stage T_1, T_(2a) and T_(2b)(100%, 100% and 94. 5% ;T_1 vs. T_(2b), χ~2 = 1.92, P =0. 166 ;T_(2a) vs. T_(2b), χ~2= 0. 35, P =0. 555), stage T_(2b) and T_3 (94. 5% and 91.3% ;χ~2 = 2. 62, P = 0. 106), or stage T_3 and T_4 (91.3% and 89. 5% ; χ~2 = 1.55, P =0. 214). The 5-year DMFS of stage N_2 was similar with stage N_1 or stage N_3(80. 2%, 86. 2% and 61. 4% ; N_2 vs. N_1, χ~2=2.22, P=0.136;N_2 vs. N_3, χ~2= 1.92, P=0.165). No statistically significant difference of 5-year OS was observed among stage Ⅰ , Ⅱ_a and Ⅱ_b(91.7%, 100% and 95. 3% ; Ⅰ vs. Ⅱ_b χ~2 =0.32, P=0.574;Ⅱ_a vs. Ⅱ_b,χ~2-0.25, P=0.617), or between Ⅳ. And Ⅳ_b(67.9% and 75. 0% ;χ~2 = 0.25, P = 0. 616). Conclusions The 6th edition of UICC/AJCC staging system shows poor predictive value for the long-term survival of NPC patients treated with IMRT.