原发肿瘤体积对鼻咽癌调强放疗预后的影响

发布时间：2018-07-31 09:58

【摘要】：研究目的:探讨调强放射治疗条件下鼻咽癌原发肿瘤体积对患者预后的影响。研究方法:我院自2004年1月至2006年12月共有330例UICC I-IVB期鼻咽癌初治患者接受调强放射治疗,入组本研究。所有患者治疗前均行CT增强扫描,扫描图像资料输人三维治疗计划系统进行肿瘤轮廓勾画,勾画完成后系统自动进行三维重建和肿瘤体积计算。我们在研究中用受试者工作特征曲线( receive operating characteristic curve, ROC曲线)确定原发肿瘤体积的临床应用截点,用Kaplan-Meier生存分析和COX比例风险回归模型分析原发肿瘤体积与患者预后的关系。研究结果:330例鼻咽癌患者所测平均原发肿瘤体积是34.2ml(0.4-153.7)。对于T1、T2、T3和T4患者,平均原发肿瘤体积分别是10.4ml(0.4-40.6)、21.9ml(3.6-75.3)、34.0ml(4.6-102.1)和68.2ml(18.9-153.7)。在2002UICC鼻咽癌T分期框架内,所有入组患者被分为4组,分组的截点是由ROC曲线确定的,分别是10ml、25ml、50ml。建立在原发肿瘤体积分组基础上,三年总生存率对于四组患者分别是88.6%, 90.0%, 91.2%和74.2% (p=0.005)。前三组累积生存率曲线非常贴近,但与第四组曲线分离明显。对于第四组患者即原发肿瘤体积超过50ml的患者,生存率较前三组明显下降。多因素分析中亦证实原发肿瘤体积同N分期一样,是影响患者生存的一个独立预后因素。结论:鼻咽癌原发肿瘤体积是影响患者生存的一个极其重要的预后因素。临床使用UICC分期评估患者预后和治疗方案时,应该充分考虑到患者原发肿瘤体积对预后的影响。我们基于该研究基础上建议考虑将原发肿瘤体积作为一个新的分期指标,补充和完善现行的鼻咽癌分期。
[Abstract]:Objective: to investigate the effect of primary tumor volume on prognosis of nasopharyngeal carcinoma (NPC) after intensity modulated radiotherapy. Methods: from January 2004 to December 2006, 330 patients with nasopharyngeal carcinoma (NPC) at UICC I-IVB stage received intensity modulated radiotherapy (IMRT). All the patients underwent CT enhanced scanning before treatment, and the scanning images were transferred into the three-dimensional treatment planning system to outline the tumor profile. After the drawing was completed, the system carried out 3D reconstruction and tumor volume calculation automatically. In our study, we determined the clinical application cutoff point of primary tumor volume by using the operating characteristic curve (receive operating characteristic curve, ROC curve), and analyzed the relationship between primary tumor volume and patients' prognosis by Kaplan-Meier survival analysis and COX proportional risk regression model. Results the mean primary tumor volume in 330 patients with nasopharyngeal carcinoma was 34.2ml (0.4-153.7). The mean primary tumor volume of patients with T _ (1) T _ (2) T _ 3 and T _ 4 were 10.4ml (0.4-40.6) ~ 21.9ml (3.6-75.3) and 68.2ml (18.9-153.7), respectively, of 34.0ml (4.6-102.1) and 18.9-153.7, respectively. Within the framework of T stage of 2002UICC nasopharyngeal carcinoma, all the patients were divided into 4 groups. The cut-off point of the group was determined by the ROC curve, which was 10ml / 25ml / 50ml, respectively. On the basis of primary tumor volume grouping, the three year overall survival rate for the four groups was 88.6, 90.0, 91.2% and 74.2%, respectively (p0.005). The cumulative survival rate curve of the first three groups was very close to that of the fourth group. The survival rate of the fourth group of patients whose primary tumor volume exceeded 50ml was significantly lower than that of the first three groups. Multivariate analysis also confirmed that primary tumor volume was an independent prognostic factor as N stage. Conclusion: primary tumor volume of nasopharyngeal carcinoma is an important prognostic factor for survival of nasopharyngeal carcinoma. The effect of primary tumor volume on prognosis should be fully taken into account when UICC staging is used to evaluate the prognosis and treatment of patients. Based on this study, we suggest to consider primary tumor volume as a new staging index to supplement and improve the current NPC staging.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R739.63

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