肿瘤体积对局部晚期鼻咽癌预后影响的倾向匹配研究  

Effect of tumor volume on prognosis of patients with local advanced nasopharyngeal carcinoma:a propensity-matched study

作　　者：胡勇[1] 张晶晶[2] 岳成山 刘亚军[1] 王会霞[1] 高山[1] 张强 张蕾 袁亮[2] HU Yong;ZHANG Jingjing;YUE Chengshan;LIU Yajun;WANG Huixia;GAO Shan;ZHANG Qiang;ZHANG Lei;YUAN Liang(Department of Radiotherapy,Central Hospital of Hanzhong City in Shanxi Province,Hanzhong,Shanxi,723000;Department of Oncology,Central Hospital of Hanzhong City in Shanxi Province,Hanzhong,Shanxi,723000)

机构地区：[1]陕西省汉中市中心医院放疗科,陕西汉中723000 [2]陕西省汉中市中心医院肿瘤内科,陕西汉中723000

出　　处：《实用临床医药杂志》2020年第20期51-54,共4页Journal of Clinical Medicine in Practice

摘　　要：目的探讨肿瘤体积(GTV)对局部晚期鼻咽癌患者预后的影响。方法分析310例接受放化疗的Ⅲ~ⅣA/B期鼻咽癌患者的临床资料及随访资料,以受试者工作特征(ROC)曲线确定治疗前GTV最佳界值为34.1 mL,选取GTV>34.1 mL患者106例纳入实验组,依据年龄、性别、卡氏功能状态量表(KPS)评分、T分期、N分期、临床分期采用倾向值匹配法,获得106例(1∶1匹配)GTV≤34.1 mL患者纳入对照组。采用Kaplan-Meier法计算生存率,以Cox回归模型进行预后因素分析。主要研究终点为无局部-区域进展生存率(LRRFS),次要研究终点为总生存率(OS)和无远处转移生存率(DMFS)。结果实验组4年LRRFS(80.2%)低于对照组(92.5%),4年OS(77.4%)低于对照组(84.0%),差异有统计学意义(P=0.008、0.043);实验组与对照组4年DMFS分别为68.9%、74.5%,差异无统计学意义(P=0.273);Cox回归模型显示,GTV>34.1 mL是LRRFS和OS的不良影响因素。结论GTV>34.1 mL是局部晚期鼻咽癌患者局部-区域进展和死亡的不良影响因素,对此类患者需增大治疗强度,以获得更好的临床疗效。Objective To evaluate the primary gross tumor volume(GTV)on prognosis in patients with local advanced nasopharyngeal carcinoma.Methods The clinical data and follow-up data of 310 patients with nasopharyngeal carcinoma inⅢto IVA/B phase undergoing chemoradiotherapy were retrospectively analyzed.The optimized critical value of GTV was confirmed as 34.1 mL by Receiver Operating Characteristic(ROC)curve analysis.A total of 106 cases with GTV>34.1 mL were included in the experimental group.Propensity matched study method was used to adjust for age,gender,Karnofsky Performance Status(KPS),tumor stage,node stage,and clinical stage.At last,a well-balanced cohort(106 cases who had GTV of less or equaling to 34.1 mL)was created by 1∶1 matching in the control group.Survival rate was calculated using Kaplan-Meier method,and prognostic factors were analyzed using Cox regression model.The primary end-point was loco-regional relapse-free survival rate(LRRFS),secondary end-points were overall survival(OS)and distant metastasis-free survival(DMFS).Results The experimental group had lower 4-year LRRFS and OS when compared to the control group(80.2%versus 92.5%,77.4%versus 84.0%,P=0.008,0.043).The 4-year DMFS of the experimental group and the control group were 68.9%and 74.5%,respectively,but no significant difference was found(P=0.273).Cox regression model showed that GTV>34.1 mL was an adverse influencing factor of LRRFS and OS.Conclusion GTV>34.1 mL is an adverse influencing factor for loco-regional progress and death in local advanced nasopharyngeal carcinoma.It is necessary to increase the treatment intensity in order to obtain better clinical efficacy.

关 键 词：鼻咽癌 肿瘤体积 预后 倾向值匹配法 

分 类 号：R739.6[医药卫生—肿瘤]