倾向性评分匹配分析淋巴结外侵犯在接受调强放疗鼻咽癌患者中的预后价值  

Propensity score matched analysis of prognostic value of extranodal extension in patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy

作　　者：黄娜 罗杨坤 冯玺 李勇 彭新皓 王宇 梁黎 秦远 HUANG Na;LUO Yangkun;FENG Xi;LI Yong;PENG Xinhao;WANG Yu;LIANG Li;QIN Yuan(Sichuan Cancer Hospital&Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041,China)

机构地区：[1]四川省肿瘤医院·四川省肿瘤研究所·四川省癌症防治中心·电子科技大学医学院放疗中心,四川成都610041

出　　处：《西部医学》2020年第11期1620-1625,1629,共7页Medical Journal of West China

基　　金：四川省科技计划项目(2020YFS0396)。

摘　　要：目的探讨淋巴结外侵犯(ENE)在鼻咽癌(NPC)患者中的预后价值。方法纳入2004年1月~2011年1月在我院初治的,并经病理学证实为非转移性鼻咽癌并接受调强放疗(IMRT)的294例NPC患者,搜集所有患者的临床资料。根据是否有ENE分为有ENE组(n=153)和无ENE组(n=141),采用倾向性评分匹配方法对两组患者进行匹配。生存分析采用Kaplan-Meier法,log-rank以及Cox回归分析。结果ENE的发生率为52.0%。ENE常伴有的特征是淋巴结坏死的发生率更高,淋巴结直径更大以及N分期更晚。在初始队列中,ENE与较差的5年远处无转移生存率(DMFS),无进展生存率(PFS),总生存率(OS)相关(65.4%vs 76.9%,P=0.020;57.5%vs 72.3%,P=0.006;71.3%vs 83.9%,P=0.028)。倾向匹配后的队列中,两组生存比较无差异[局部无复发生存率(LRFS):92.0%vs 92.4%,P=0.656;区域无复发生存率(RRFS):97.3%vs 95.5%,P=0.474;DMFS:71.0%vs 70.6%,P=0.801;PFS:65.9%vs 62.8%,P=0.907;OS:75.7%vs 80.0%,P=0.558]。多因素COX回归分析确认ENE不是鼻咽癌患者生存的独立预后因素。结论ENE不是接受IMRT治疗NPC患者的独立预后因素。Objective Extranodal extension(ENE)is commonly seen in cervical node metastasis of nasopharyngeal carcinoma(NPC),however,the prognostic value of ENE is contradictory.In the present study,we evaluated the prognostic value of ENE in patients with NPC using a propensity score-matched analysis(PSM).Methods 294 patients with NPC and receiving intensity-modulated radiotherapy(IMRT)were retrospectively analyzed.Patients with ENE and without ENE were matched using PSM method.Survival analysis was analyzed with Kaplan-Meier method,log-rank test and Cox regression.Results The incidence of ENE was 52.0%.ENE was characterized by a higher incidence of cervical nodal necrosis,a larger node diameter size and higher N stage.In the original cohort,ENE was significantly associated with poorer 5-year distant metastasis-free survival(DMFS)(65.4 vs.76.9%,P=0.020),progression-free survival(PFS)(57.5 vs.72.3%,P=0.006)and overall survival(OS)(71.3 vs.83.9%,P=0.028).In the propensity-matched cohort,no significant survival differences were observed between the two groups(local recurrence-free survival(LRFS):92.0%vs.92.4%,P=0.656;regional recurrence-free survival(RRFS):97.3%vs.95.5%,P=0.474;DMFS:71.0%vs.70.6%,P=0.801;PFS:65.9%vs.62.8%,P=0.907;OS:75.7%vs.80.0%,P=0.558).Multivariate COX regression analysis confirmed that ENE is not an independent prognostic factor for the survival of NPC.Conclusion ENE is not an independent prognostic factor for patients with NPC treated with IMRT.

关 键 词：鼻咽癌 结外侵犯 倾向性评分匹配 调强放疗 

分 类 号：R739.6[医药卫生—肿瘤]