鼻咽癌疗前原发灶及区域淋巴结坏死与3DRT预后关系  

Prognostic value of pretreatment primary tumor and regional lymph node necrosis in nasopharyngeal carcinoma with 3DRT

作　　者：张相国[1] 梁思贤 韩非[2] 徐晓南[1] 程英[3] 黄菊红[1] 寇梦瑛 

机构地区：[1]汕头大学医学院附属粤北人民医院放疗科,韶关512026 [2]华南肿瘤学国家重点实验室中山大学肿瘤防治中心放疗科,广州510060 [3]汕头大学医学院附属粤北人民医院影像科,韶关512026

出　　处：《中华放射肿瘤学杂志》2016年第12期1285-1289,共5页Chinese Journal of Radiation Oncology

基　　金：广东省医学科研基金（A2012687）;韶关市卫生计生科研项目（Y16014）;韶关市科技计划项目（2016ws003）

摘　　要：目的 探讨鼻咽癌患者原发灶及区域淋巴结坏死的临床特征与鼻咽癌预后关系.方法 收集2009—2013年间粤北人民医院477例初治鼻咽癌患者的临床资料,根据疗前影像学鼻咽部原发灶及区域淋巴结坏死情况、MRI及CT检查,分析疗前鼻咽部原发灶及区域淋巴结坏死的临床特征及与3DRT预后关系.采用Kaplan-Meier法计算生存率,Logrank检验和单因素分析及Cox模型多因素预后分析.结果 疗前有肿瘤坏死者219例（45.9%）,无肿瘤坏死者258例（54.1%）.有肿瘤坏死与无坏死的中位生存期分别为37个月与40个月,3年OS、PFS、LRFS及DMFS率分别为78.2%与93.7%、63.8%与86.7%、87.0%与96.3%及79.7%与93.4%（P均=0.000）.单因素分析结果显示肿瘤坏死是影响患者OS、PFS、LRFS、DMFS的重要影响因素（P均=0.000）,而T分期、N分期及临床分期与患者OS、PFS、DMFS相关（P=0.000-0.004）.多因素分析显示疗前肿瘤坏死是影响4种生存的预测因子（P=0.001-0.022）,T分期是影响LRFS、DMFS的预测因子（P=0.016、0.006）,N分期是影响PFS的预测因子（P=0.000）.结论 疗前存在肿瘤坏死患者易出现复发或转移,生存期更短.在T分期、N分期基础上参考肿瘤坏死状态有利于临床医师制定更加合理的治疗方案和改善预后.Objective To investigate the clinical features and prognostic value of primary tumor and regional lymph node necrosis in nasopharyngeal carcinoma （ NPC） . Methods Clinical data were collected from 477 patients newly diagnosed with NPC in our hospital from 2009 to 2013. Pretreatment MRI and CT scans of primary tumor and regional lymph nodes were performed to analyze the clinical features and prognostic value of primary tumor and regional lymph node necrosis after 3DRT. The survival rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. Univariate and multivariate prognostic analyses were made by the log-rank test and the Cox model. Results In the 477 patients, 219 （ 45.9%） had tumor necrosis and 258 （ 54.1%） had not. The patients without tumor necrosis had significantly longer median survival time and significantly higher 3-year overall survival （ OS） , progression-free survival （PFS）, local recurrence-free survival （LRFS）, and distant metastasis-free survival （DMFS） rates than those with tumor necrosis （ 40 vs. 37 months, 93.7% vs. 78.2%, 86.7% vs. 63.8%, 96.3% vs. 87.0%, 93.4% vs. 79.7%, all P=0. 000 ） . The univariate analysis showed that tumor necrosis was an important influencing factor for OS, PFS, LRFS, and DMFS rates in patients. T stage, N stage, and clinical stage were correlated with OS, PFS, and DMFS rates in patients （ P=0.000-0.004）. The multivariate analysis showed that pretreatment tumor necrosis were predictive factors for all survival in patients with NPC （P=0.001-0.022）,with T stage for LRFS,DMFS （P=0.016,0.006） and N stage for PFS （P=0.000）. Conclusions Patients with pretreatment tumor necrosis are likely to have recurrence or metastasis as well as shorter survival time than those without tumor necrosis. On the basis of T/N stage, identification of the state of tumor necrosis helps clinical physicians to make more reasonable treatment plans and improve the prognosis.

关 键 词：肿瘤坏死 鼻咽肿瘤/三维放射疗法 预后 

分 类 号：R739.63[医药卫生—肿瘤] R730.55[医药卫生—临床医学]