美国癌症研究联合会第七版肿瘤分期对鼻咽癌放疗预后的影响  

The different impact of 7th ed AJCC cancer staging system on nasopharyngeal carcinoma treated with conventional radiotherapy and intensity-modulated radiotherapy

作　　者：林少俊[1] 潘建基[1] 韩露[1] 陈传本[1] 张瑜[1] 陈奇松[1] 林锦[1] 张秀春[1] 

机构地区：[1]福建医科大学教学医院福建省肿瘤医院放疗科,福州350014

出　　处：《中华放射肿瘤学杂志》2011年第6期458-461,共4页Chinese Journal of Radiation Oncology

基　　金：福建省自然科学基金

摘　　要：目的观察美国癌症研究联合会（AJCC）第7版肿瘤分期标准对鼻咽癌常规放疗（CRT）和调强放疗（IMRT）预后的影响。方法用AJCC第7版肿瘤TNM分期标准对本院2004-2006年接受CRT和IMRT的鼻咽癌患者重新分期和分析预后。共1138例患者入组，CRT790例，IMRT348例。CRT和IMRT患者中位年龄分别为47岁和45岁（χ2=1．49，P=0．222），男女比例分别为580：210和266：82（χ2=1．15，P=0．303），Ⅰ、Ⅱ、Ⅲ、Ⅳ期例数分别为0、41、488、261和5、65、176、102例（χ2=64．78，P=0．001）。比较两种放疗的3年疗效，Kaplan-Meier法计算生存率并Logrank法检验。结果3年随访率为96．0％。常规、IMRT患者中位随访时问分别为32、33个月，死L例数分别为113、35例。N分期是影响常规、IMRT总生存和无远处转移生存的因素（χ2=6．50、13．60，P=0．038、0．004和χ2=7．78、15．30，P=0．009、0．002），临床分期对CRT总牛存有影响（χ2=6．70，P=0．035）、埘IMRT无远处转移生存有影响（χ2=9．12，P=0．028）。结论第7版AJCCT分期仍不能满足准确判断鼻咽癌预后的需要，N分期是影响鼻咽癌总生存和无远处转移生存的重要预后因素。Objective To compare the prognostic value of the 7th edition of AJCC cancer staging system in nasopharyngeal carcinoma （NPC） patients treated with conventional radiotherapy （CRT） and intensity-modulated radiotherapy （IMRT）. Methods From January 2004 to December 2006, totally 1138 NPC patients were treated with CRT （790 patients） and IMRT （348 patients） in Cancer Hospital of Fujian province. The median ages were 47 and 45 years old for two groups （χ2 = 1.49 ,P =0. 222） , respectively. There were 0, 41, 488, 261 and 5, 65, 176, 102 patients in stage Ⅰ、Ⅱ、Ⅲ、Ⅳof the two groups after restaged with 7th edition of AJCC cancer staging system, respectively （ χ2 = 64.78, P = 0. 001 ）. The 3-year survival was analyzed according to T-category, N-category and overall stage. Results The follow-up rate at 3 years is 96.0%. The median follow-up were 32 months and 33 months tor CRT and IMRT groups. N- category was fbund to be the prognostic factors for overall survival （ OS, χ2 = 6. 50, P = 0. 038 and χ2 = 13.60, P =0. 004） and metastasis free survival （MFS, χ2 =7.78, P =0. 009 and χ2 = 15.30, P =0. 002） for CRT and IMRT groups. The clinical stage was prognostic factor for OS in conventional group （ χ2 = 6. 70, P =0. 035）, and for MFS in IMRT group （χ2 = 9. 12, P = 0. 028）. Conclusions The T-calegory of 7th AJCC staging system shows poor predictive value for the long-term survival of NPC patients. The N-calegory of 7th AJCC staging system can well estimate the OS and MFS for NPC.

关 键 词：美国癌症研究联合会第7版分期系统 鼻咽肿瘤/二维放射疗法 鼻咽肿瘤/三维放射疗法 预后 

分 类 号：R73[医药卫生—肿瘤]