Comparison of the prognosis of advanced T and N stage in patients with nasopharyngeal carcinoma
-
摘要:
目的 回顾性分析局部T晚期与N晚期鼻咽癌患者的预后情况，为临床鼻咽癌治疗提供参考。 方法 选取2011年12月至2017年11月西部战区总医院经病理确诊为鼻咽癌的局部T晚期患者102例、局部N晚期患者162例的临床病例资料，分为两组并分析患者的预后情况。 结果 局部T晚期与N晚期患者5年总生存率（overall survival，OS）分别为82.8%与75.8%（P=0.271）、无疾病进展生存率（progression-free survival，PFS）分别为73.7%与62.8%（P=0.043），无局部复发生存率（local relapse-free survival，LRFS）分别为87.6%与91.6%（P=0.646）、无远处转移生存率（distant metastasis-free survival，DMFS）分别为87.7%与79.5%（P=0.066），两组间PFS差异具有统计学意义。 结论 局部N晚期鼻咽癌患者的DMFS、OS、PFS均有下降趋势，临床上局部N晚期鼻咽癌患者应更强调系统性治疗以及分层治疗的意义，以争取更高的OS并降低远处转移。 Abstract:Objective To retrospectively compare the prognosis between patients with locally advanced T and N stage nasopharyngeal carcinoma (NPC), to provide a reference for the clinical treatment of NPC. Methods A total of 264 NPC cases from December 2011 to November 2017 visiting The General Hospital of Western Theater Command were pathologically diagnosed and retrospectively analyzed. Of these, 102 and 162 were locally advanced T and N stage, respectively. Results The two groups 5-year overall survival (OS), progression-free survival (PFS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were compared. These were 82.8% and 75.8% (P=0.271), 73.7% and 62.8% (P=0.043), 87.6% and 91.6% (P=0.646), 87.7% and 79.5% (P=0.066), respectively. Conclusions The DMFS, OS and PFS decreased in patients with locally advanced N stage NPC, although there was no statistical difference. The significance of systemic and stratified treatment should be emphasized in patients with locally advanced N stage NPC in order to achieve a higher OS rate and reduce distant metastasis. -
Key words:
- nasopharyngeal carcinoma /
- advanced T stage /
- advanced N stage /
- prognosis
-
表 1 264例鼻咽癌患者临床特征
表 2 264例鼻咽癌患者TNM分期例（%）
-
[1] Chen YP, Chan A, Le QT, et al. Nasopharyngeal carcinoma[J]. Lancet, 2019, 394(10192):64-80. [2] Chua MLK, Wee JTS, Hui EP, et al. Nasopharyngeal carcinoma[J]. Lancet, 2016, 387(10022):1012-1024. [3] Sun XS, Li XY, Chen QY, et al. Future of radiotherapy in nasopharyngeal carcinoma[J]. Br J Radiol, 2019, 92(1102):20190209. http://cn.bing.com/academic/profile?id=be803aa4c982cdeaf752833bf3730c8a&encoded=0&v=paper_preview&mkt=zh-cn [4] Guo R, Mao YP, Tang LL, et al. The evolution of nasopharyngeal carcinoma staging[J]. Br J Radiol, 2019, 92(1102):20190244. http://cn.bing.com/academic/profile?id=c41b4b9c38791871a067e229a40c0b5a&encoded=0&v=paper_preview&mkt=zh-cn [5] Lee AW, Ma BB, Ng WT, et al. Management of nasopharyngeal carcinoma: current practice and future perspective[J]. J Clin Oncol, 2015, 33(29):3356-3364. http://cn.bing.com/academic/profile?id=ca9f0ab7b255ff27e8a3d345f0a2419e&encoded=0&v=paper_preview&mkt=zh-cn [6] Xu JH, Guo WJ, Bian XH, et al. A comparative study of locoregionally advanced nasopharyngeal carcinoma treated with intensity modulated irradiation and platinum-based chemotherapy[J]. Cancer Radiother, 2013, 17(4):297-303. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=8be00750e21fb170efd57576116141e3 [7] Zeng L, Tian YM, Sun XM, et al. Intensity-modulated radiotherapy for stage IVA/IVB nasopharyngeal carcinoma: clinical outcomes and patterns of failure in an endemic area in China[J]. Strahlenther Onkol, 2014, 190(11):993-1000. http://cn.bing.com/academic/profile?id=7ab9fdb46a6300e46b6bee4032288e2f&encoded=0&v=paper_preview&mkt=zh-cn [8] 中国鼻咽癌临床分期工作委员会.中国鼻咽癌分期2017版(2008鼻咽癌分期修订专家共识)[J].中华放射肿瘤学杂志, 2017, 26(10):1119-1125. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhfszl201710003 [9] 蒋朝阳, 张涛, 高辉, 等.428例鼻咽癌患者颈部及Ⅴ区后缘转移淋巴结位置分布规律研究[J].中国肿瘤临床, 2016, 43(19):855-859. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgzllc201619007 [10] 夏云飞, 钱剑扬, 张恩罴, 主编.实用鼻咽癌放射治疗学[M].北京:北京医科大学出版社, 2003:38-50. [11] 尹珍珍, 王优优, 张希梅, 等.不同诱导化疗方案联合放疗治疗鼻咽癌疗效分析[J].中国肿瘤临床, 2018, 45(4):179-184. http://journal11.magtechjournal.com/Jwk_zgzllc/CN/abstract/abstract13824.shtml [12] 冯梅, 范子煊, 黎杰, 等.582例鼻咽癌调强放疗5年远期疗效及预后分析[J].中华放射肿瘤学杂志, 2011, 20(5):369-373. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhfszl201105003 [13] Zhao C, Miao JJ, Hua YJ, et al. locoregional control and mild late toxicity after reducing target volumes and radiation doses in patients with locoregionally advanced nasopharyngeal carcinoma treated with induction chemotherapy (IC) followed by concurrent chemoradiotherapy: 10-year results of a phase 2 study[J]. Int J Radiat Oncol Biol Phys, 2019, 104(4):836-844. [14] 华贻军, 洪明晃, 罗东华, 等.406例鼻咽癌患者预后多因素分析[J].中国肿瘤临床, 2005, 32(8):435-438. http://journal11.magtechjournal.com/Jwk_zgzllc/CN/abstract/abstract11909.shtml [15] Blanchard P, Lee A, Marguet S, et al. Chemotherapy and radiotherapy in nasopharyngeal carcinoma: an update of the MAC- NPC metaanalysis[J]. Lancet Oncol, 2015, 16(6):645-655. http://www.sciencedirect.com/science/article/pii/S1470204515701269 [16] Li AC, Xiao WW, Shen GZ, et al. Distant metastasis risk and patterns of nasopharyngeal carcinoma in the era of IMRT: long-term results and benefits of chemotherapy[J]. Oncotarget, 2015, 6(27):24511-24521. http://cn.bing.com/academic/profile?id=d29972b9e2e13b957e3a942958e966a2&encoded=0&v=paper_preview&mkt=zh-cn [17] Lee AWM, Tung SY, Ng WT, et al. A multicenter, phase 3, randomized trial of concurrent chemoradiotherapy plus adjuvant chemotherapy versus radiotherapy alone in patients with regionally advanced nasopharyngeal carcinoma: 10-year outcomes for efficacy and toxicity[J]. Cancer, 2017, 123(21):4147-4157. http://cn.bing.com/academic/profile?id=4d41c84efea230db37d2e88de9e53aef&encoded=0&v=paper_preview&mkt=zh-cn [18] Peng H, Chen L, Zhang J, et al. Induction chemotherapy improved long term outcomes of patients with locoregionally advanced nasopharyngeal carcinoma: a propensity matched analysis of 5-year survival outcomes in the era of intensity-modulated radiotherapy[J]. J Cancer, 2017, 8(3):371-377. http://cn.bing.com/academic/profile?id=6f251e8d55afc846f8fc8c6e19444236&encoded=0&v=paper_preview&mkt=zh-cn [19] Chen YP, Guo R, Liu N, et al. Efficacy of the additional neoadjuvant chemotherapy to concurrent chemoradiotherapy for patients with locoregionally advanced nasopharyngeal carcinoma: a bayesian network meta-analysis of randomized controlled trials[J]. J Cancer, 2015, 6(9):883-892. http://cn.bing.com/academic/profile?id=ed5a6d78db6ded6364cd149da8631690&encoded=0&v=paper_preview&mkt=zh-cn [20] Cao SM, Yang Q, Guo L, et al. Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: A phase III multicentre randomised controlled trial[J]. Eur J Cancer, 2017, 75: 14-23. http://cn.bing.com/academic/profile?id=d5241cbc3097338173c50e20d9342ee6&encoded=0&v=paper_preview&mkt=zh-cn [21] Setakornnukul J, Thephamongkhol K. Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in locally advanced nasopharyngeal carcinoma[J]. BMC Cancer, 2018, 18(1):329. http://cn.bing.com/academic/profile?id=879a680a24f483f230b4bad842dccdf0&encoded=0&v=paper_preview&mkt=zh-cn [22] Zeng Z, Yan RN, Tu L, et al. Assessment of concurrent chemoradiotherapy plus induction chemotherapy in advanced nasopharyngeal carcinoma: cisplatin, fluorouracil, and docetaxel versus gemcitabine and cisplatin[J]. Sci Rep, 2018, 8(1):15581. http://cn.bing.com/academic/profile?id=91a55ad935132642a3b9cecc5f792f11&encoded=0&v=paper_preview&mkt=zh-cn [23] Chen X, Long X, Liang Z, et al. Higher N stage and serum ferritin, but lower serum albumin levels are associated with distant metastasis and poor survival in patients with nasopharyngeal carcinoma following intensity-modulated radiotherapy[J]. Oncotarget, 2017, 8(42):73177-73186. http://cn.bing.com/academic/profile?id=0914facbc1b2829299f86a01f34a9bc3&encoded=0&v=paper_preview&mkt=zh-cn -
下载:
点击查看大图
图(1) / 表(2)
计量
- 文章访问数: 193
- HTML全文浏览量: 45
- PDF下载量: 9
- 被引次数: 0
