基于调强放疗的鼻咽癌分期探讨  

Evaluation of staging system for nasopharyngeal carcinoma based on intensity-modulated radiotherapy

作　　者：曾雷[1] 龚晓昌[1] 敖帆[1] 汤轶强[1] 舒禹先[1] 万桂芬[1] 肖芸[1] 廖瑜露[1] 黄敏[1] 谢琛[1] 蒋春灵[1] 李金高[1] 

机构地区：[1]江西省肿瘤医院放疗科,南昌330029

出　　处：《中华放射肿瘤学杂志》2015年第3期285-289,共5页Chinese Journal of Radiation Oncology

摘　　要：目的 验证鼻咽癌第7版UICC或AJCC分期,并为其进一步修订提供依据.方法 收集2005-2011年间本院收治的经病理确诊、无远处转移并接受根治性IMRT的初治鼻咽癌患者323例.根据鼻咽癌第7版UICC或AJCC分期标准进行分期.Kaplan-Meier计算生存率,Logrank法检验差异,Cox模型多因素预后分析.结果 5年样本数为45例.T1与T2期、T2与T3期5年LRFS率相近（P=0.055、P=0.746）.将T2、T3和T4期翼内肌组合并为T2期,T4期其他的降期为T3期,新T分期中T1、T2、T3期LRFS曲线明显分开.N2与N3a期、N2与N3b期、N3a与N3b期5年DMFS率相近（P =0.272、P=0.063、P=0.810）.多因素分析结果显示颈淋巴结部位是DMFS的唯一影响因素（P =0.037）.将N3a期中颈淋巴为单侧的降期为N1期,N3a期中颈淋巴结为双侧的降期为N2期,则新N分期中N0、N1、N2、N3期DMFS曲线分开.Ⅰ与Ⅱ期、Ⅲ与Ⅳa期5年OS相近（P=0.434、P=0.951）.将T1N0-1期作为Ⅰa期、T2N0-1期作为Ⅰb期、T1.N2期和（或）T3N0-1期作为Ⅱ期、T1-3N3期作为Ⅲ期,各期5年OS曲线明显分开.结论 第7版UICC或AJCC分期仍存在不足,推荐新分期能更好预测预后,但需要更大样本量数据验证.Objective To evaluate the 7th edition of the International Union against Cancer/ American Joint Committee on Cancer （UICC/AJCC） staging system for nasopharyngeal carcinoma （NPC）,and to provide a basis for its further revision.Methods Three hundred and twenty-three patients who were pathologically diagnosed with NPC （without distant metastasis） and received radical intensity-modulated radiotherapy （IMRT） in our hospital from 2005 to 2011 were enrolled as subjects.All patients were staged according to the 7th edition of the UICC/AJCC staging system.The overall survival （OS）,local recurrencefree survival （LRFS）,and distant metastasis-free survival （DMFS） rates were calculated using the KaplanMeier method,and pairwise comparisons were made by the log-rank test.Multivariate prognostic analyses were performed using the Cox regression model.Results The 5-year sample size was 45.There were no significant differences in 5-year LRFS between stages T1 and T2,as well as between stages T2 and T3 （P =0.055;P =0.746）.The current stages T2,T3,and T4 with only medial pterygoid muscle were combined into stage T2,and the rest of stage T4 were down-staged to stage T3.In the new T staging system,the LRFS curves of stages T1,T2,and T3 were substantially separated.There were no significant differences in 5-year DMFS between stage N2 and N3a,between stage N2 and N3b,and between stages N3a and N3b （P =0.272;P =0.063;P =0.810）.Multivariate analyses demonstrated that cervical lymph node metastasis was the only independent prognostic factor for DMFS （P =0.037）.The current stage N3a with cervical lymph node metastasis on one side was down-staged to stage N1,and the current stage N3a with cervical lymph node metastasis on both sides to stage N2.In the new N staging system,the DMFS curves of stages N0,N1,N2,and N3 were substantially separated.There were no significant differences in 5-year OS between stages Ⅰ and Ⅱ,as well as between stages Ⅲ and Ⅳa （P =0.434;P =0.951）.The current stages T1 N

关 键 词：鼻咽肿瘤/调强放射疗法 分期 预后 

分 类 号：R739.63[医药卫生—肿瘤]