局部晚期鼻咽癌放疗结束后影像学残留患者的预后分析  

Prognostic analysis of patients with localized imaging residues of nasopharyngeal carcinoma after radiotherapy

作　　者：肖勤 李战战 赵雅洁[3] XIAO Qin;LI Zhanzhan;ZHAO Yajie(Department of Radiology,Xiangya Hospital,Central South University,Changsha,Hunan 410008,China;Department of Oncology,Xiangya Hospital,Central South University,Changsha,Hunan 410008,China;Department of Nuclear Medicine,Xiangya Hospital,Central South University,Changsha,Hunan 410008,China)

机构地区：[1]中南大学湘雅医院放射科,湖南长沙410008 [2]中南大学湘雅医院肿瘤科,湖南长沙410008 [3]中南大学湘雅医院核医学科,湖南长沙410008

出　　处：《中国医学工程》2020年第8期5-10,共6页China Medical Engineering

基　　金：湖南省自然科学基金青年基金(2018JJ3827)。

摘　　要：目的寻找调强适形放射治疗(IMRT)结束3~24个月影像学证实有肿瘤残留的局部晚期鼻咽癌患者的预后因素,为局部残留鼻咽癌患者选择优化的综合治疗方案提供依据。方法通过使用SPSS 23.0软件,寿命表法计算生存率,通过Kaplan-Meier法绘制生存曲线图。通过单、多因素分析年龄、性别、放疗剂量、化疗方案、分子靶向治疗、局部残留情况等因素对患者预后的影响。结果 (1)局部晚期鼻咽癌患者5年总生存率(OS)、局部无复发生存率(LRFS)、无远处转移生存率(DMFS)分别为70.8%、78.5%、77.5%;(2)单因素分析发现原发鼻咽肿瘤(GTVnx)残留体积、原发鼻咽肿瘤及颈部转移淋巴结(GTVnx+nd)残留体积、美国癌症联合会(AJCC)分期(第7版)及放疗剂量是影响OS的重要因素,GTVnx残留体积、GTVnx+nd残留体积还是影响LRFS的重要因素。多因素Cox回归分析结果发现:AJCC分期(H^R=3.81, 95%CI:0.58~11.76)、放疗剂量(H^R=4.05, 95%CI:1.22~12.25)为影响OS的独立预后因素(P<0.05);GTVnx残留体积(H^R=4.90, 95%CI:1.33~18.13)为影响LRFS的独立预后因素(P<0.05)。结论肿瘤分期、原发病灶的总处方剂量可以给临床判断有肿瘤残留的局部晚期鼻咽癌患者预后提供一定的参考价值,但也应考虑鼻咽癌放疗后局部残留体积及残留时间等因素,从而更加全面地评估该类患者的预后,并为其个体化治疗提供依据。【Objective】 To seek the influencing factors impact on the survival rate of nasopharyngeal carcinoma after intensity modulated radiation therapy(IMRT). 【Methods】 A retrospective analysis was made of 74 patients with nasopharyngeal carcinoma residual confirmed by imaging at the end of IMRT. SPSS17.0 statistical software was used. The rate of 5-year overall survival(OS),local recurrence-free survival(LRFS), distant metastasis-free survival(DMFS) were calculated. Survival curves were plotted by Kaplan-Meier method. The prognostic factors such as age, sex, radiation dose of PGTVnx, chemotherapy, targeted and residual volume/time were analyzed by multiple factors. 【Results】 The 5-year OS, LRFS, DMFS were 70.8%, 78.5%, 77.5%. Single factor analysis identified that the residual volume of the GTVnx, the residual volume of the GTVnx+nd, AJCC staging and radiotherapy dose were important influencing factors of OS, and the residual volume of the GTVnx, the residual volume of the GTVnx+nd would affect LRFS. Multiple factors regression analysis showed that AJCC staging and radiation dose were independent prognostic factors of OS(P<0.05);the residual volume of the GTVnx was an independent prognostic factor of LRFS(P<0.05). 【Conclusion】 Cancer staging and total prescription dose of the primary lesion can provide references for the prognosis of patients with localized residues of nasopharyngeal carcinoma, but the residual volume and time after radiotherapy should be considered, which can comprehensively assess the prognosis of patients.

关 键 词：鼻咽癌 影像学残留 调强适形放射治疗 预后分析 

分 类 号：R769.6[医药卫生—耳鼻咽喉科]