481例鼻咽癌患者预后及分期研究

发布时间：2018-08-13 14:32

【摘要】：第一章481例鼻咽癌患者预后及分期研究目的回顾性分析湘雅医院481例初诊鼻咽癌患者的临床资料及治疗效果、不良反应,并探索其预后因素,并对'92福州分期及6th AJCC分期进行比较,评价两种分期的风险一致性及差异性。方法收集从2005年1月到2008年12月在本院接受治疗的481例鼻咽癌患者临床资料,分析其临床特征及总生存率、无瘤生存率、无局部复发生存率及无远处转移生存率,按照’92福州分期及6th AJCC分期对所有病例重新进行分期,比较两种分期方式的T分期、N分期、临床分期及其对预后的预测价值。比较两种分期的风险一致性及差异性,进行预后的多因素分析,P0.05为差异有统计学意义。结果1)中位随访时间为44个月(10-75个月),4年无局部复发率、无远处转移率、无瘤生存率及总生存率分别为90.4%、75.0%、68.2%、76.0%。相比与’92福州分期,6th AJCC分期中Ⅱ期病例的比例增高,Ⅲ期、Ⅳ期病例的比例降低。从T分期比较来看,总生存曲线以’92福州分期分开相对较好。’92福州分期中,T2与T3组、T3与T4组之间差异无统计学意义,P值分别为0.128和0.473。6th AJCC分期中,T1和T2组、T2与T3组、T3与T4组之间差异无统计学意义,P值分别为0.053、0.071和0.918。’92福州分期中,NO与N1组、N2与N3组之间差异无统计学意义,P值分别为0.931和0.721。6th AJCC分期中,NO与N1组、N2与N3组之间差异无统计学意义,P值分别为0.645和0.578。’92福州分期中,Ⅲ期与Ⅳ期曲线之间差异无统计学意义,P值为0.196。6th AJCC分期中,Ⅲ期与Ⅳ期曲线之间差异无统计学意义,P值为0.281。2)单因素分析表明年龄、有无颈鞘侵犯、有无颅底侵犯、临床分期、T分期、N分期、淋巴结侧数(单/双侧)为影响总生存率的相关因素；颈鞘侵犯、颅底侵犯、颅神经侵犯、临床分期、T分期、N分期、淋巴结侧数为无瘤生存率的相关因素；临床分期、T分期、放疗方式、化疗方式、有无使用增敏剂为无局部复发生存率的相关因素；性别、颈鞘侵犯、颅底侵犯、分期、T分期、N分期为无转移生存率的相关因素(两种分期都有统计学意义,P0.05)。3)分期因素是影响鼻咽癌最重要的的独立预后因素：T分期和N分期对总生存率、无远处转移生存率及无瘤生存率的影响有统计学意义,T分期和放疗方式对无局部复发率的影响有统计学意义。是否采用调强适形放射治疗技术为局部复发的独立预后因素,调强适形放射治疗组的局部复发的风险较2D—常规放射治疗组低,有统计学差异(P=0.018)。结论T分期和N分期对总生存率、无远处转移生存率及无瘤生存率的影响有统计学意义,T分期和放疗方式对无局部复发率的影响有统计学意义。第二章鼻咽癌调强适形放疗与常规放疗的疗效及预后因素比较目的放疗是治疗鼻咽癌的主要手段。本研究对鼻咽癌患者调强适形放疗与常规放疗的疗效及预后因素进行比较。方法收集2005年1月至2008年12月在我院经病理活检确诊,无远处转移的初治鼻咽癌患者,调强适形放射治疗放疗组182例,常规放射治疗放疗组198例。进行回顾性病例对照研究,比较两组的临床资料、疗效及预后因素。结果1)调强适形放射治疗组和常规放射治疗组的4年无局部复发率、无转移生存率、无瘤生存率、总生存率分别为93.6%和85.3%、79.1%和73.6%、74.7%和65.0%、83.5%和72.1%。调强适形放射治疗组的4年无局部复发率及总生存率比常规放射治疗组高,而两组的无转移生存率及无瘤生存率无统计学差异。2)调强适形放射治疗组的急性皮肤及口腔粘膜反应、急性唾液腺反应与常规放射治疗组比较差异有统计学意义(P0.05),而骨髓抑制反应差异无统计学意义(P0.05)。调强适形放射治疗组发生各种晚期反应的患者比例和严重程度小于常规放射治疗组。3)多因素分析结果表明,常规放射治疗组临床分期或T和N分期与鼻咽癌无瘤生存率、无转移生存率及总生存率显著相关,T分期与鼻咽癌无局部复发率显著相关。而调强适形放射治疗组T分期、N分期与各生存率无显著相关。结论调强适形放射治疗治疗鼻咽癌相较于常规放射治疗,无局部复发率和总生存率提高,不良反应减轻。进行调强适形放射治疗治疗的鼻咽癌患者,T分期不是各生存率的独立预后因素。为了减少远处转移需采取更有效方法。随着鼻咽癌治疗中调强适形放射治疗应用增加,目前的分期系统面临新的挑战。
[Abstract]:Chapter one: prognosis and staging of 481 patients with nasopharyngeal carcinoma
Objective To retrospectively analyze the clinical data, therapeutic effect, adverse reactions and prognostic factors of 481 cases of nasopharyngeal carcinoma newly diagnosed in Xiangya Hospital, and to compare the'92 Fuzhou Stage with the 6th AJCC Stage, and to evaluate the risk consistency and difference between the two stages.
Methods The clinical data of 481 patients with nasopharyngeal carcinoma treated in our hospital from January 2005 to December 2008 were collected. The clinical characteristics and overall survival rate, tumor-free survival rate, local recurrence-free survival rate and distant metastasis-free survival rate were analyzed. All patients were re-staged according to'92 Fuzhou Stage and 6th AJCC Stage, and the two stages were compared. Type T staging, N staging, clinical staging and their predictive value for prognosis were compared. Multivariate analysis of prognosis showed that the difference was statistically significant (P 0.05).
Results 1) The median follow-up time was 44 months (10-75 months), 4 years without local recurrence, distant metastasis, tumor-free survival rate and overall survival rate were 90.4%, 75.0%, 68.2%, 76.0%, respectively. Compared with'92 Fuzhou Stage, the proportion of stage II cases in 6th AJCC Stage was higher, and that of stage III and IV cases was lower. There was no significant difference between T2 and T3 groups, T3 and T4 groups in Fuzhou staging, P values were 0.128 and 0.473.6th in AJCC staging, T1 and T2 groups, T2 and T3 groups, T3 and T4 groups, P values were 0.053, 0.071 and 0.918 respectively. There was no significant difference in P values between 0.931 and 0.721.6th AJCC stages. There was no significant difference between NO and N1, N2 and N3, P values were 0.645 and 0.578.'92 in Fuzhou stages. There was no significant difference between stage III and stage IV curves. P values were 0.196.6th AJCC stages, and there was no difference between stage III and stage IV curves. Univariate analysis showed that age, cervical sheath involvement, skull base involvement, clinical stage, T stage, N stage, and the number of lymph nodes (unilateral / bilateral) were the related factors affecting the overall survival rate; cervical sheath involvement, skull base involvement, cranial nerve involvement, clinical stage, T stage, N stage, and lymph node side were the relative factors affecting the overall survival rate. Related factors: clinical stage, T stage, radiotherapy, chemotherapy, sensitizer use or not were the relevant factors for non-local recurrence survival rate; gender, cervical sheath invasion, skull base invasion, stage, T stage, N stage were the most important factors for non-metastatic survival rate (both stages were statistically significant, P 0.05). 3) Staging factors were the most important factors affecting NPC. Independent prognostic factors: T-stage and N-stage had statistically significant effects on overall survival, distant metastasis-free survival and tumor-free survival, T-stage and radiotherapy had statistically significant effects on local recurrence. The risk of local recurrence in the treatment group was lower than that in the 2-D-conventional radiotherapy group (P=0.018). Conclusion T-stage and N-stage have statistically significant effects on the overall survival rate, distant metastasis-free survival rate and tumor-free survival rate, and T-stage and radiotherapy have statistically significant effects on the rate of local recurrence.
The second chapter is the comparison of curative effect and prognostic factors between intensity modulated radiotherapy and conventional radiotherapy for nasopharyngeal carcinoma.
Objective To compare the efficacy and prognostic factors of intensity modulated radiation therapy (IMRT) and conventional radiotherapy (CRT) for nasopharyngeal carcinoma (NPC).
Methods From January 2005 to December 2008, 182 patients with nasopharyngeal carcinoma were treated with intensity modulated radiation therapy (IMRT) and 198 patients with routine radiation therapy (CRT).
Results 1) The 4-year local recurrence rate, metastasis-free survival rate and tumor-free survival rate were 93.6% and 85.3%, 79.1% and 73.6%, 74.7% and 65.0%, 83.5% and 72.1% respectively in IMRT group and conventional radiotherapy group. The 4-year local recurrence-free rate and overall survival rate in IMRT group were higher than those in conventional radiotherapy group. There was no significant difference in metastasis-free survival rate and tumor-free survival rate between the two groups. Multivariate analysis showed that clinical stage or T and N stages were significantly associated with tumor-free survival, metastasis-free survival and overall survival of NPC. T stage was significantly associated with non-local recurrence of NPC. There was no significant correlation between T stage and N stage.
Conclusion Compared with conventional radiotherapy, IMRT has no higher local recurrence rate and overall survival rate, and less adverse reactions. T stage is not an independent prognostic factor for survival in patients with nasopharyngeal carcinoma treated with IMRT. The application of intensity modulated radiation therapy (IMRT) is increasing, and the current staging system is facing new challenges.
【学位授予单位】：中南大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R739.63

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