鼻咽癌调强放疗后影像学残留情况及相关因素的临床分析

发布时间：2018-06-25 14:32

本文选题：鼻咽癌 + 调强适形放疗　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:回顾性分析经调强适形放射治疗(IMRT)的474例鼻咽癌患者局部或区域影像学残留情况,并寻求与之相关联的因素,以对影像学残留患者的治疗提供参考。方法:回顾性分析2010年1月至2012年12月广西医科大学第一附属医院经病理学证实、接受IMRT、无远处转移的初治鼻咽癌患者474例。分析各患者放疗结束时影像学残留情况、残留部位及残留消退时间。采用SPSS 19.0统计软件,Kaplan-Meier方法分析相关因素对预后的影响。组间差异采用Logistic回归检验,多因素分析采用Cox回归模型。卡方检验分析各因素对局部或区域影像学残留的影响,多因素采用Logistic回归分析。P0.05为差异有统计学意义。结果:(1)2010年1月至2012年12月在我院初治的474例鼻咽癌1、3、4年总生存率(OS)分别为93.04%、85.02%、82.91%,1、3、4年无复发生存率(LRFS)为91.77%、82.49%、79.11%,1、3、4年无远处转移生存率(DMFS)为91.14%、80.59%、77.63%;行调强适形放疗(IMRT)后局部或区域影像学残留为47.7%(226/474),其中单纯鼻咽原发灶残留患者103例,单纯颈部淋巴结残留患者65例,原发灶及颈部淋巴结均有残留患者58例。残留组3个月内消退率17.3%(39/226),3-6内月消退率35.4%(80/226)。放疗结束时完全缓解与放疗后3个月内完全缓解患者的生存曲线相近。(2)单因素分析:年龄、2010UICC总分期、T分期、N分期、放疗结束时影像学残留为预后相关因素;口咽、椎前肌、颈动脉鞘区、翼内肌、翼外肌、颅底、鼻窦、颞下窝、颅内、海绵窦、颅神经侵犯、2010UICC总分期、T分期为影响局部影像学残留的相关因素,化疗、IIa、III、Iva、VIIa区淋巴结、边缘强化、坏死为影响淋巴结影像学残留的相关因素。(3)多因素分析结果显示年龄50、N分期较晚、放疗结束时影像学残留为预后不良因素,颅底侵犯为影响局部影像学残留的相关因素,III、VIIa区淋巴结为影响淋巴结影像学残留的相关因素,差异均有统计学意义(P0.05)。结论:鼻咽癌患者放疗结束时约半数存在影像学残留,放疗后3个月评价疗效是合理的;颅底侵犯可能与放疗后局部影像学残留有关;III、VIIa区淋巴结可能与淋巴结影像学残留有关。
[Abstract]:Objective: to retrospectively analyze the local or regional imaging residues in 474 patients with nasopharyngeal carcinoma (NPC) treated by intensity modulated conformal radiotherapy (IMRT). Methods: from January 2010 to December 2012, 474 cases of primary nasopharyngeal carcinoma (NPC) with no distant metastasis confirmed by pathology in the first affiliated Hospital of Guangxi Medical University were analyzed retrospectively. The imaging residue, residual site and residual regression time at the end of radiotherapy were analyzed. Kaplan-Meier method was used to analyze the influence of related factors on prognosis. Logistic regression test and Cox regression model were used for multivariate analysis. Chi-square test was used to analyze the influence of various factors on the local or regional imaging residues. Logistic regression analysis was used to analyze the multiple factors. The difference was statistically significant. Results: (1) from January 2010 to December 2012, the overall survival rate (OS) of 474 patients with nasopharyngeal carcinoma (NPC) in our hospital from January 2010 to December 2012 was 93.04 and 85.02, respectively. The total survival rate (OS) was 93.04 and 85.02, respectively. The 4-year recurrence free survival rate (LRFS) was 91.7772.491.79.1113, and the 4-year non-metastasis survival rate (DMFS) was 91.141480.5977.633.The local or regional shadow after IMRT was performed with strong intensity conformal radiotherapy (IMRT). The imaging residue was 47.7% (226 / 474), including 103 patients with primary nasopharynx residual, There were 65 cases of residual cervical lymph nodes, 58 cases of primary lesions and cervical lymph nodes. The regression rate of residual group within 3 months was 17.3% (39 / 226) and 35.4% (80 / 226) in 3-6 months. The survival curve of patients with complete remission at the end of radiotherapy was similar to that within 3 months after radiotherapy. (2) univariate analysis: age / 2010 UICC total stage / T stage / N stage, imaging residual at the end of radiotherapy was a prognostic factor, oropharynx, prevertebral muscle, oropharynx, prevertebral muscle, Carotid sheath area, medial pterygoid muscle, lateral pterygoid muscle, skull base, paranasal sinus, infratemporal fossa, intracranial, cavernous sinus, cranial nerve invasion of UICC total stage T stage were related factors affecting local imaging residual. (3) the results of multivariate analysis showed that the age of 50 N stage was relatively late, and the imaging residue at the end of radiotherapy was a bad prognostic factor. The invasion of the skull base was the related factor of local imaging residue. The lymph nodes in the IIIV IIa region were the related factors of the imaging residue of lymph nodes, and the differences were statistically significant (P0.05). Conclusion: about half of the patients with nasopharyngeal carcinoma have imaging residues at the end of radiotherapy, and it is reasonable to evaluate the curative effect 3 months after radiotherapy, and the invasion of skull base may be related to the local imaging residue after radiotherapy, and the lymph nodes in the region of VIIa may be related to the residual lymph nodes.
【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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