基于调强放疗的鼻咽癌中国2008分期和UICC2010分期标准的临床对比研究

发布时间：2018-05-12 21:54

本文选题：鼻咽癌 + 分期　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:通过回顾性分析345例初治鼻咽癌调强放疗患者的临床及生存资料,比较鼻咽癌中国2008分期(以下简称2008分期)与UICC2010分期(以下简称2010分期)标准的合理性,为鼻咽癌分期系统的修订提供进一步依据。方法:收集2011年11月-2012年12月在广西医科大学第一附属医院放疗科经病理证实、首诊并符合入组条件的370例鼻咽癌患者资料(随访到345人,随访率93.2%),对所有患者分别按照2008及2010分期标准进行分期。采用Kappa法进行各期病例分布的一致性检验,Kaplan-Meier法计算各种生存率,Log-rank法进行差异性检验。结果:(1)345例鼻咽癌患者3年总生存率(OS)、无复发生存率(RFS)、无远处转移生存率(DMFS)分别为:81.4%、93.4%、86.7%。(2)两种分期标准临床、T及N分期Kappa值分别为0.659、0.727、0.811(P值均=0.000),临床及T分期一致性中等,N分期一致性最好。(3)2008分期与2010分期的临床分期、T分期及N分期总生存曲线走势良好(P0.05),但各组间差异均不明显。2008分期中,II期与IVa、III期与IVa期差异有统计学意义;T1与T4、T2与T4、T3与T4之间差异有统计学意义;N0与N3、N1b与N2、N1b与N3之间差异有统计学意义,其余各期均无统计学意义。2010分期中II期与IVa、II期与IVb期、III期与IVb期有统计学意义;T1与T4、T2与T4之间差异有统计学意义;N0与N2、N0与N3b、N1与N2、N1与N3b之间有统计学差异,其余各期均无统计学差异。(4)两种分期标准中临床分期、T分期及2008分期标准N分期的无复发生存曲线相互交叉,差异无统计学意义(P0.05);2010分期标准N分期无复发生存曲线无明显重叠(P0.05),仅N1与N3b之间有统计学差异,其余各期均无统计学意义。(5)两种分期系统中T分期、临床分期的无远处转移生存曲线相互重叠,差异无统计学意义(P0.05);N分期能较好的预测无远处转移生存情况(P0.05)。2008分期中N1a与N1b曲线相互靠拢,N0与N2、N0与N3、N1a与N3、N1b与N3之间差异有统计学差异,其余各期均无统计学差异;2010分期中,N3a与N3b相互交叉,N0与N2、N0与N3a、N0与N3b、N1与N2、N1与N3a、N1与N3b之间差异有统计学意义,其余各期均无统计学差异。将2008分期中N1a与N1b融合,2010分期N3a与N3b融合后,两种分期无转移生存各曲线分开良好,除N0与N1、N2与N3之间无统计学差异,其余各期均有意义。结论:1.中国2008分期与UICC2010分期标准的N分期具有较好的一致性,临床及T分期一致性中等。2.两种分期标准临床分期、T分期、N分期均能预测总生存率;N分期均能预测无远处转移生存率,但各组间差异不显著。3.两种分期标准临床分期、T分期、N分期对无复发生存率影响较少;临床分期、T分期对无远处转移生存率影响较少。4.两种分期标准对鼻咽癌调强放疗疗效预测结果相近。
[Abstract]:Objective: to analyze retrospectively the clinical and survival data of 345 patients with nasopharyngeal carcinoma treated with intensity modulated radiotherapy (IMRT), and to compare the reasonableness of Chinese 2008 staging (2008 staging) and UICC2010 staging (2010 stage) for nasopharyngeal carcinoma. To provide further basis for the revision of nasopharyngeal carcinoma staging system. Methods: from November 2011 to December 2012, 370 patients with nasopharyngeal carcinoma (NPC) who were confirmed pathologically by radiotherapy in the first affiliated Hospital of Guangxi Medical University were collected. The follow-up rate was 93. 2%. All patients were staging according to the 2008 and 2010 staging criteria. Kappa method was used to test the consistency of case distribution. Kaplan-Meier method was used to calculate the survival rate and Log-rank method was used to test the differences. Results the 3-year overall survival rate and recurrence free survival rate and distant metastasis survival rate in 345 patients with nasopharyngeal carcinoma were 0.6590.270.811P and 0.0000.000 respectively. The Kappa values of the two staging criteria were 0.659and 0.7270.811P, respectively. The overall survival curve of T stage and N stage was better than that of 2010 stage, but there was no significant difference between the two groups. There were significant differences in T 1 and T 4 T 2 between 2008 stage and IVa stage. There was significant difference between T _ 4T _ 3 and T _ 4. There was significant difference between N0 and N3N _ 1b and N _ 2N _ 1b and N _ 3. There was no statistical significance in the other stages. There were statistical differences between stage II and stage Iva II and stage IVb, stage III and stage IVb. There were significant differences between T1 and T4T _ 2 and T _ 4. There were significant differences between N0 and N2N0 and N3bN1and N2N3b, and between N3b and N2N _ 1, there was no significant difference between N0 and N2N _ 0 and N2N _ 2N _ 1 and N3b. There was no statistical difference in other stages. (4) the recurrence free survival curves of clinical staging T stage and 2008 stage N stage were intersected. There was no significant difference in the survival curve of the standard N staging without recurrence. There was only a statistical difference between N1 and N3b, and there was no significant difference in T staging in the other stages. The survival curve without distant metastasis in clinical staging overlapped with each other. There was no significant difference between P0.05N stage and N3N1a stage. The N1a and N1b curves were close to N0 and N2N0 and N3N1a and N3N1b were closely related to N3 in the stage of P0.05. 2008, and there was a significant difference between N1a and N1b and N3N1b, N3, N1a, N1a, N1b, N1b, N1b and N3. There was no statistical difference between N3a and N3b in the other stages. There was no significant difference between N3a and N3b in 2010 stage. After the fusion of N1a and N1b in stage 2008 and stage N3a and N3b in 2010, the survival curves of N1a and N3b in the two stages were well separated, except that there was no statistical difference between N0 and N1N _ 2 and N _ 3, the other stages were significant. Conclusion 1. There was good consistency between 2008 staging in China and N staging in UICC2010 staging standard. The consistency of clinical and T staging was moderate. 2. 2. Both types of clinical staging and T staging and N staging could predict the overall survival rate and N stage, but there was no significant difference between the two groups. Two kinds of clinical staging standard T staging and N staging had little effect on recurrence free survival rate, and clinical staging T stage had less effect on distant metastasis survival rate. The two staging criteria were similar in predicting the therapeutic effect of intensity modulated radiotherapy for nasopharyngeal carcinoma (NPC).
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.63

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