鼻咽癌2008分期在局部区域晚期病例中适用性分析  

Analysis of China 2008 Staging System on nasopharyngeal carcinoma in locoregionally advanced cases

作　　者：许建华[1] 卞秀华[1] 王婷婷[1] 郭文杰[1] 姜雪松[1] 朱向帜[1] 黄生富[1] 何侠[1] 张宜勤[1] 

机构地区：[1]南京医科大学附属江苏省肿瘤医院放疗科,江苏南京210009

出　　处：《中华肿瘤防治杂志》2014年第7期518-521,共4页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的:探讨中国鼻咽癌2008分期在局部晚期鼻咽癌中的适用性。方法:将2009-01-01-2010-12-31南京医科大学附属江苏省肿瘤医院放疗科连续收治的局部晚期鼻咽癌(Ⅲ及ⅣA期)181例纳入分析。181例患者全部接受调强放疗。176例(97.2%)患者接受铂类为基础的同步化疗,其中41例(22.7%)还接受了相同方案的辅助化疗。随访后比较各个分期患者的无进展生存曲线,并探讨2008分期的适用性。结果:2008分期对Ⅲ及ⅣA期患者,在放疗后1年内无进展生存率分别为87.7%和82.5%。主要原因是Ⅲ及ⅣA期患者中N2患者远处转移率均较高,且主要发生在治疗开始后的1年内,导致两组患者生存曲线前期紧贴。将全部患者按N分期(分为N0、N1、N2及N3)重新分组,4组间的无进展生存曲线能良好区分,χ2=13.7,P=0.003;在相似的N分期下,不同T分期的无进展生存曲线相互交错,N0和N1时,T3与T4,P=0.816;N2和N3时,T1和T2与T3及T4,P=0.944。多因素分析结果相似。结论:在调强放射治疗和铂类同步化疗的背景下,2008分期对不同N分期的无进展生存曲线区分良好,但在N分期相似的情况下,对不同的T分期的无进展生存曲线区分不佳。OBJECTIVE： To discuss the suitability of China 2008 Staging System on nasopharyngea/ carcinoma （NPC） in locoregionally advanced cases. METHODS ： Totally 181 consecutive pathologically confirmed, nonmetastatic, un-treated patients with stage Ⅲ or Ⅳ A between Jan. 2009 and Dec. 2010 were reviewed. All patients were treated with de-finitive IMRT with 176 patients（97. 2%） receiving platinum based concurrent chemotherapy. Among them, 41 patients （22.7 % ） received adjuvant chemotherapy with the same regimen. Progression-free survival curves were compared between different stages after regular follow up. RESULTS： The progression free survival ct, rves of stage Ⅳ and Ⅳ A sticked to each other at the first 12 months after registration due to an early and high incidence of metastasis in patients with Na ,and after that the curvs separated well. They were 87.7% and 82.5% 1 year later,85.3% and 76.3% 2 years later,79. 3% and 69.3 % 3 years later. If recalculation was proceeded based on N stage（N0, N1, N2 and N3 ）, the PFS curves separated well （X^2 = 13.7,P=0. 003）. In the observed period,patients with the same N classification but different T classification had similar PFS（N0, and N1 ,T3 versus T4 ,P 0. 816;N2, and N3,T1 and T2 versus T 3versus T4,P=0. 944）. The Coxproportion hazards model confirmed the results mentioned above. CONCLUSIONS： In the context of IMRT and platinum-based concurrent chemotherapy,the recommended staging system can well separate the PFS curves of patients with different N classifications, but it can not separate the PFS curves of patients with different T classifications under similar N classifications.

关 键 词：鼻咽肿瘤 肿瘤分期 调强放疗 放射疗法 

分 类 号：R739.63[医药卫生—肿瘤]