初治转移性鼻咽癌预后因素及治疗模式探讨

发布时间：2019-04-29 17:22

【摘要】：【目的】回顾性分析230例初治转移鼻咽癌的独立预后因素以及治疗模式,筛选出预后较好亚组,从而提高治疗效果。【方法】选择230例符合入组标准的初治鼻咽癌转移病例纳入本研究,中位年龄48岁,最常见的转移部位为骨(67.0%)、肝(32.6%)、肺(15.7%)等,全部患者至少接受1个疗程的以铂类为基础的联合化疗,中位化疗周期为5个,将预后不利因素纳入多因素Cox比例风险回归模型中分析。【结果】全组中位随访时间为21个月,中位生存时间为24个月,3年、5年总生存率分别为27.8%、16.7%。化疗的整体反应率、有效控制率分别为55.6%、89.1%,其中CR/PR、SD、PD分别为55.6%、33.5%、10.9%。影响总生存的独立不利预后因素包括:卡氏评分KPS80(P0.01)、N2-3(P=0.01)、合并肝转移(P0.01)、转移数目超过3个(P0.01)、血红蛋白120 g/L(P0.01)、乳酸脱氢酶245 U/L(P0.01)、化疗周期1~3个(P0.001)、转移灶化疗疗效为PD或SD(P0.001)、原发灶未接受放疗(P0.001)、转移灶未接受处理(P0.001)。转移灶的化疗疗效与KPS、是否合并肝转移、化疗周期、乳酸脱氢酶、是否合并多器官转移、转移数目是否超过3个等因素有关。【结论】基于KPS、N分期、是否合并肝转移、转移数目、血红蛋白、乳酸脱氢酶、化疗疗效等7个独立预后因素有助于预测患者的生存,同时也有助于临床上更好的筛选出预后较好的群体。部分预后较好的患者采用积极的治疗方式包括4个或超过4个周期的化疗、原发灶放疗、转移灶处理等能有效患者的提高总生存,甚至获得长期生存。
[Abstract]:[objective] to analyze the independent prognostic factors and treatment model of 230 cases of newly diagnosed metastatic nasopharyngeal carcinoma (NPC), and to screen out the better prognosis subgroup. [methods] 230 newly diagnosed cases of nasopharyngeal carcinoma metastasis were selected and included in this study. The median age was 48 years old. The most common metastatic sites were bone (67.0%) and liver (32.6%), the most common metastatic sites were bone (67.0%) and liver (32.6%), and the median age was 48 years old. Lung (15.7%), all patients received at least one course of platinum-based chemotherapy, with a median chemotherapy cycle of 5. [results] the median follow-up time was 21 months, median survival time was 24 months, 3-year and 5-year survival rates were 27.8% and 16.7%, respectively. The overall survival rate was 27.8% and 16.7%, respectively. The mean survival time was 24 months, 3 years and 5-year survival rates were 27.8% and 16.7%, respectively. The overall response rate and effective control rate of chemotherapy were 55.6% and 89.1% respectively, and the CR/PR,SD,PD were 55.6%, 33.5% and 10.9% respectively. Independent adverse prognostic factors affecting total survival included KPS80 (P0.01), N2 / 3 (P0.01), liver metastasis (P0.01), metastasis over 3 (P0.01) and hemoglobin 120g / L (P0.01). The efficacy of chemotherapy was PD or SD (P0.001), the primary focus was not treated with radiotherapy (P0.001) and the metastatic focus was not treated (P0.001). The effect of chemotherapy on metastatic foci was related to whether KPS, was complicated with liver metastasis, chemotherapy cycle, lactate dehydrogenase, multiple organ metastasis or not, and whether or not the number of metastasis was more than 3. [conclusion] based on KPS,N stage, liver metastasis is associated with metastasis. Seven independent prognostic factors, such as the number of metastasis, hemoglobin, lactate dehydrogenase and chemotherapeutic effect, are helpful to predict the survival of the patients, and also help to screen out the population with better prognosis in clinic. Positive treatment including four or more cycles of chemotherapy, radiotherapy of primary foci, treatment of metastatic foci and so on can improve the total survival and even obtain long-term survival of patients with good prognosis in some patients. 4 or more cycles of chemotherapy, radiotherapy of primary foci and treatment of metastatic foci can improve the total survival of patients.
【作者单位】：赣州市人民医院肿瘤科;江西省肿瘤医院放疗科;赣州市人民医院放射介入科;广东省惠州市中心医院肿瘤科;中山大学肿瘤防治中心;
【分类号】：R739.63

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