中国1992、2008和UICC2010分期标准预测鼻咽癌放疗疗效的比较研究

发布时间：2018-06-29 09:27

本文选题：鼻咽肿瘤 + 分期　；参考：《苏州大学》2011年硕士论文

【摘要】：目的目前国际上尚未应用统一的鼻咽癌临床分期,我国在1992分期的基础上于2008年制定了2008分期标准,而国际抗癌联盟(UICC)也于2010年发布了最新的第七版鼻咽癌分期标准。但是,现在非常缺乏分期标准相互之间优劣性的比较,不利于相互之间指导治疗、评估疗效和学术交流。我们通过对347例鼻咽癌患者的回顾性分析,比较鼻咽癌中国1992、2008和UICC 2010分期标准之间的一致性,评价它们在预测鼻咽癌放疗疗效中的价值。方法回顾性分析347例无远处转移的初治鼻咽癌患者的临床资料,对每例患者分别用中国1992、2008和UICC 2010分期标准进行T、N和临床分期。采用Kappa法分析不同分期标准之间各期病例数分布的一致性,采用Kaplan-Meier法分别评估三种分期标准的临床分期、T分期和N分期对总生存率、局部无复发生存率和无远处转移生存率的影响,Log-rank检验其差异性。结果中国2008分期和UICC 2010分期标准之间的临床分期、T和N分期的病例构成比例的一致性均优于它们各自与1992分期之间的比较,Kappa值分别为0.700、0.881、0.722;2008分期和UICC2010分期标准分别与1992分期标准在临床分期、T分期、N分期病例构成比的比较中T分期一致性较好,Kappa值分别为0.570和0.548、0.877和0.761、0.485和0.531。2008分期和UICC 2010分期标准下各临床分期的总生存曲线走势均优于1992分期(χ~2=36.30, P=0.000;χ~2=37.73, P=0.000;χ~2=33.19, P=0.000);1992分期中Ⅲ期和Ⅳ期的总生存曲线相互交错(χ~2=0.401,P=0.526);三种分期标准的T1与T2、T2与T3、T3和T4期之间的局部无复发生存率均无统计学差异(χ~2=0.529、0.502、1.849,P=0.467、0.479、0.174和χ~2=2.096、1.986、1.248,P=0.148、0.159、0.264及χ~2=0.595、0.873、0.768,P=0.441、0.350、0.381);1992分期标准中N_0与N_1、N_1与N_2、N_2与N_3之间均无统计学差异(χ~2=3.712、3.113、2.014,P=0.054、0.078、0.156),2008分期标准中N_1与N_2,N_2与N_3之间有统计学意义(χ~2=10.488、5.059,P=0.001、0.024);UICC 2010分期标准中仅N_1与N_2之间有统计学差异(χ~2=7.731,P=0.0054)。结论中国2008分期和UICC2010分期标准的病例构成比例的一致性优于它们各自与1992分期之间的比较结果。三种分期标准均能提示鼻咽癌患者的放疗疗效,但中国2008分期和UICC2010分期标准对鼻咽癌患者放疗疗效的预测结果相近并都显著优于1992分期。
[Abstract]:Objective at present, a unified clinical staging of nasopharyngeal carcinoma has not been applied internationally. On the basis of 1992 stages, China established a 2008 staging standard in 2008, and the international anticancer Alliance (UICC) issued the latest seventh edition of the 7th edition of nasopharyngeal carcinoma staging standard. However, it is now very short of the comparison of the advantages and disadvantages of the staging standards, which is not beneficial to each other. A retrospective analysis of 347 patients with nasopharyngeal carcinoma, compared with the Chinese 19922008 and UICC 2010 staging criteria, was used to evaluate the value of them in predicting the efficacy of radiotherapy for nasopharyngeal carcinoma.
Methods the clinical data of 347 patients with nasopharyngeal carcinoma without distant metastasis were retrospectively analyzed. T, N and clinical staging were used for each patient with Chinese 19922008 and UICC 2010 staging criteria respectively. The conformance of the number distribution between different stages of different staging criteria was analyzed by Kappa method, and three staging criteria were evaluated by Kaplan-Meier method. The clinical staging, T staging and N staging had the effect on overall survival rate, local recurrence free survival rate and no distant metastasis survival rate, and Log-rank test was different.
Results the clinical staging between the Chinese 2008 staging and the UICC 2010 staging criteria was better than the comparison between the T and the N staging. The Kappa value was 0.700,0.881,0.722, the 2008 staging and the UICC2010 staging were respectively in the clinical staging, T staging, and N staging, respectively. The T staging was better in comparison, and the trend of total survival curves of each clinical stage under the Kappa values of 0.570 and 0.548,0.877 and 0.761,0.485, 0.531.2008 staging and UICC 2010 staging were superior to 1992 stages (x ~2=36.30, P=0.000; Chi ~2=37.73, P=0.000; Chi ~2=33.19, P=0.000); and the total subsistence of stage III and IV in the 1992 stages. The lines interlaced with each other (x ~2=0.401, P=0.526); there were no statistical differences in the local recurrence rates of T1 and T2, T2 and T3, T3 and T4 stages between the three staging standards (P=0.467,0.479,0.174 and Chi ~2=2.096,1.986,1.248, P=0.148,0.159,0.264 and chi square); and the 1992 staging standards 1, there was no statistical difference between N_1 and N_2, N_2 and N_3 (x ~2=3.712,3.113,2.014, P=0.054,0.078,0.156), N_1 and N_2 in the 2008 staging standard, and statistically significant between N_2 and N_3 (chi ~2=10.488,5.059, P=0.001,0.024), and there was a statistical difference between the 2010 staging standards.
Conclusion the consistency of the proportion of Chinese 2008 staging and UICC2010 staging is better than the comparison between their respective and 1992 stages. The three staging criteria can both indicate the efficacy of radiotherapy for nasopharyngeal carcinoma, but the Chinese 2008 staging and UICC2010 staging criteria are similar and significant in predicting the radiotherapy effect of nasopharyngeal carcinoma patients. Better than 1992 stages.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R739.63

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