214例鼻咽癌同步放化疗长期生存预后多因素分析  

Long term efficacy and prognostic analysis of 214 nasopharyngeal carcinoma patients

作　　者：黄泽黎[1] 徐韬[1] 魏伟宏[1] 陈清环[1] 冯洁栈[1] 张国义[1] 卢秋霞[1] 

机构地区：[1]中山大学附属佛山医院放疗科,广东佛山528000

出　　处：《中华肿瘤防治杂志》2015年第7期537-541,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的评估不同的同步化疗方案(多西他赛或顺铂)及顺铂累积剂量强度(>200mg/m2或≤200mg/m2)对鼻咽癌长期生存的影响及其预后因素。方法回顾性分析2006-07-01-2009-06-30中山大学附属佛山医院接受同步放化疗的鼻咽癌患者214例,41例同步每周多西他赛化疗,173例同步每周顺铂化疗;其中顺铂同步化疗患者中,62例顺铂累积总量≤200 mg/m2,111例顺铂累积总量>200 mg/m2;155例治疗前检测了血浆EBV-DNA水平,其中47例≥1 500copies/mL。结果多西他赛组和顺铂组5年总生存率(overall survival,OS)分别为71.2%和81.9%,P=0.306;无进展生存率(progression-free survival,PFS)分别为66.8%和79.1%,P=0.133;无远处转移生存率(disea-free survival,DFS)分别为74.1%和86.5%,P=0.110;无局部复发生存率分别为87.1%和90.5%,P=0.452,差异均有统计学意义。顺铂累积总量>200 mg/m2 5年PFS为84.3%,比顺铂累积总量≤200 mg/m2的69.4%明显提高,P=0.018;顺铂累积总量>200mg/m2 DFS为89.9%,比顺铂累积总量≤200mg/m2的80.4%明显降低,P=0.042;治疗前血浆EBV DNA≥1 500copies/mL组和治疗前EBV DNA<1 500copies/mL组5年PFS分别为59.9%和81.5%,P=0.002;DFS分别为71.8%和87.6%,P=0.009;OS分别为64.6%和86.8%,P=0.001。结论每周顺铂方案在同步放化疗的耐受性良好,顺铂累积总量>200mg/m2改善PFS和DFS,每周多西他赛同步化疗与每周顺铂同步化疗远期疗效相似。治疗前血浆EBV-DNA水平是影响生存的重要预后因素。OBJECTIVE We retrospectively compared the long-term efficacy of concurrent chemotherapy regimens （do- eetaxel vs cisplatin） for nasopharyngeal carcinoma and total dose intensity of cisplatin （〉200 mg/m2 vs ≤200 mg/m2） ,and in- vestigated the prognostic factors for concurrent chemoradiotherapy. METHODS 214 patients diagnosed and treated with concurrent chemoradiotherapy were enrolled in a single institute in an endemic area. Forty-one patients received weekly do- eetaxel; 173 received weekly cisplatin. Among the cisplatin-treated patients, 62 cases received cumulative doses 200 mg/m2 and 111 cases received cumulative doses 200 mg/m2. Pretreatment Epstein-Burr virus （EBV） DNA lev- els were available for 155 of 214 patients. RESULTS Concurrent weekly docetaxel and cisplatin had similar 5-year OS rates （71.2% vs 81.9% ,P： 0. 306） ,PFS （66.8% vs 79.1% ,P= 0. 133） ,DFS （74.1% vs 86.5% ,P=0. 110） ,and LFS （87.1% vs 90.5% ,P = 0. 452）. Cumulative cisplatin 〉200 mg/m2 improved the 5-year rates of PFS （84.3% vs 69.4%, P=0. 018） and DFS （89.9% vs 80.4% ,P=0. 042） significantly in comparison with cumulative cisplatin ≤200 mg/m2. Pretreatment plasma EBV DNA levels ≥1 500 copies/mL was closely associated with poor DFS （71.8% vs 87.6% ,P： 0. 009）,PFS （59.9% vs 81.5%,P=0. 002） ,and OS （64.6% vs 86.8%,P=0. 001）. CONCLUSIONS Weekly cisplatin is well tolerated in concurrent ehemoradiotherapy,and cumulative cisplatin 〉200 mg/m2 can improve PFS and DFS. The long-term efficacy of concurrent docetaxel is similar to that of concurrent cisplatin. Pretreatment plasma EBV DNA copy number is the most significant prognostic factor for survival.

关 键 词：鼻咽肿瘤 同步放化疗 顺铂 多西他赛 EBV-DNA水平 预后因素 

分 类 号：R739.63[医药卫生—肿瘤]