中晚期鼻咽癌调强适形放疗结束时局部或区域影像学残留患者预后分析

发布时间：2019-03-25 15:41

【摘要】：目的：通过回顾性分析局部中晚期鼻咽癌调强适形放疗后影像学上有残留的患者预后情况及预后相关因素,寻求预后不良的因素,进一步指导个体化的综合治疗。 方法和材料：回顾性分析选取2008年8月～2012年1月期间135例在中南大学湘雅医院肿瘤放疗科行调强适形放疗(IMRT)的局部中晚期鼻咽癌患者,放疗结束时影像学证实有残留。采用SPSS17.0统计软件,寿命表法计算2年及3年总生存率、无复发生存率、无远处转移生存率,Kaplan-Meier法绘制生存曲线图。单因素采用Kaplan-Meier方法分析年龄、性别、临床分期、放疗剂量、化疗方式、靶向治疗、放疗增敏剂治疗、肿瘤残留部位、残留体积、残留时间等对预后的影响,组间生存率差异采用Log-rank检验。多因素分析采用Cox回归模型,P0.05为差异有统计学意义。 结果：(1)2008年8月～2012年1月在我院初治的135例局部中晚期鼻咽癌行调强适形放疗后局部或区域影像学残留患者2年和3年总生存率(OS)分别为80%和72%,2年和3年无复发生存率(RFS)分别为77%和74%,2年和3年无远处转移生存率(DMFS)分别为74%为69%；(2)单因素分析：2008T分期、PGTVnx处方总剂量、靶向治疗、鼻咽部残留有无、颈部淋巴结残留体积、残留时间为影响无病生存率的相关因素,2008N分期、2008T分期、2008总分期、PGTVnx处方总剂量、靶向治疗、鼻咽部残留有无、颈部淋巴结残留体积、残留时间为影响总生存率的相关因素,2008N分期、PGTVnx处方总剂量、PGTVnxD95、靶向治疗、鼻咽部残留有无、颈部淋巴结残留体积、残留时间为影响无复发生存的相关因素,2008N分期、2008T分期、2008总分期、PGTVnx处方总剂量、PGTVnx D95、靶向治疗、鼻咽部残留有无、颈部淋巴结残留体积、残留时间为影响无转移生存率的相关因素；(3)多因素分析结果显示颈部淋巴结残留体积是影响鼻咽癌无病生存率、无复发生存率、无转移生存率及总生存率的独立预后因素,靶向治疗是影响总生存的独立预后因素,差异均有统计学意义(P0.05)。 结论：颈部淋巴结残留体积与患者预后有关(残留体积≤5cc患者的生存预后优于残留体积5cc的患者)；同步放化疗加靶向治疗的总生存比单纯同步放化疗差；辅助化疗未能提高患者的生存率；放疗剂量对生存预后的影响无统计学意义。
[Abstract]:Objective: to analyze retrospectively the prognosis and prognostic factors of patients with residual imaging after local intensity modulated conformal radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) in order to find out the factors of poor prognosis and to guide the individualized comprehensive therapy. Methods and materials: from August 2008 to January 2012, a total of 135 patients with locally moderate and advanced nasopharyngeal carcinoma (NPC) who underwent intensity modulated conformal radiotherapy (IMRT) in the Department of tumor radiotherapy, Xiangya Hospital, Central South University, were retrospectively analyzed. The imaging evidence was residual at the end of radiotherapy. The total 2-and 3-year survival rate, recurrence-free survival rate and distant metastasis-free survival rate were calculated by SPSS17.0 statistical software and life table method. The survival curve was plotted by Kaplan-Meier method. The effects of age, sex, clinical stage, radiotherapy dose, chemotherapy mode, targeted therapy, radiosensitizer therapy, residual site, residual volume and residual time on prognosis were analyzed by Kaplan-Meier method. The difference of survival rate between groups was tested by Log-rank test. Multivariate analysis using Cox regression model, P0.05 was statistically significant. Results: (1) from August 2008 to January 2012, the 2-year and 3-year overall survival rates (OS) were 80% and 72%, respectively, for the patients with local or regional residual imaging after intensity modulated conformal radiotherapy in our hospital. The 2-year and 3-year recurrence-free survival rates (RFS) were 77% and 74% respectively, and the 2-year and 3-year distant metastasis-free survival rates (DMFS) were 74% and 69%, respectively. (2) univariate analysis: 2008T stage, total dose of PGTVnx prescription, targeted therapy, residual nasopharynx, residual volume of neck lymph node, residual time were the related factors of disease-free survival rate, 2008N stage, 2008T stage, 2008 total staging. The total dose of PGTVnx prescription, targeted therapy, residual nasopharynx, residual volume of cervical lymph nodes and residual time were the related factors affecting the overall survival rate, 2008N stage, total dose of PGTVnx prescription, targeted PGTVnxD95, therapy and nasopharyngeal residual. The residual volume and time of residual cervical lymph node were the related factors of non-recurrence survival. 2008 N stage, 2008 T stage, 2008 total staging, total dose of PGTVnx prescription, PGTVnx D95, targeted therapy, residual nasopharynx, residual volume of cervical lymph node. Residual time was related to metastasis-free survival rate. (3) the results of multivariate analysis showed that the residual volume of cervical lymph nodes was an independent prognostic factor affecting disease-free survival rate, recurrence-free survival rate, metastasis-free survival rate and total survival rate of nasopharyngeal carcinoma, and targeted therapy was an independent prognostic factor affecting overall survival. The difference was statistically significant (P0.05). Conclusion: the residual volume of cervical lymph nodes is related to the prognosis of patients (the survival prognosis of patients with residual volume 鈮，

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