新辅助化疗后再分期联合放疗治疗局部晚期鼻咽癌的疗效观察  

Effect observation on neoadjuvant chemotherapy followed by reassess staging and combined with radiotherapy for advanced nasopharyngeal carcinoma

作　　者：王伟锋[1] 袁峰[1] 林志仁[1] WANG Wei-feng;YUAN feng;LIN Zhi-ren(Department of Radiation Oncology,Affiliated Haikou Hospital of Central South University Xiangya School,Haikou 570208,China)

机构地区：[1]中南大学湘雅医学院附属海口医院肿瘤放疗科,海南海口570208

出　　处：《中华肿瘤防治杂志》2021年第7期508-512,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的探讨新辅助化疗强度及化疗后降期与否对鼻咽癌治疗预后的影响。方法选取2009-10-01-2012-10-01海口市人民医院接受新辅助化疗的鼻咽癌初治患者226例。患者根治性放疗前行2~4个周期新辅助化疗,影像学检查评估疗效,重新进行临床分期,分为降期组(196例)和未降期组(30例),2组患者均行根治性放疗及同步化疗,完成全部治疗后按期进行随访。SPSS 20.0对数据进行统计学分析,Kaplan-Meier法绘制生存曲线。结果所有患者生存率3年为88.1%(95%CI=0.76~0.89),5年为75.4%(95%CI=0.69~0.78),中位生存期67个月。完成诱导化疗后,196例患者降期,30例未降期,降期组和未降期组中位生存时间分别为68和45个月。降期组和未降期组患者3年总生存率为91.0%(95%CI=0.89~0.93)和69.5%(95%CI=0.66~0.72),差异有统计学意义,χ^(2)=8.47,P=0.005;5年为81.6%(95%CI=0.78~0.86)和53.3%(95%CI=0.49~0.61),差异有统计学意义,χ^(2)=9.15,P=0.001。降期组和未降期组患者3年无进展生存期(FFS)为84.6%(95%CI=0.76~0.88)和62.7%(95%CI=0.59~0.68),差异有统计学意义,χ^(2)=6.82,P=0.008;5年为76.5%(95%CI=0.71~0.89)和42.6%(95%CI=0.40~0.51),差异有统计学意义,χ^(2)=8.93,P=0.007。降期组和未降期组患者3年局部无复发生存期(local recurrence-free survival,LRFS)为95.0%(95%CI=0.90~0.98)和82.3%(95%CI=0.78~0.87),差异有统计学意义,χ^(2)=5.52,P=0.010;5年为82.3%(95%CI=0.77~0.89)和43.2%(95%CI=0.39~0.48),差异有统计学意义,χ^(2)=7.87,P=0.002。诱导化疗预后完成2个周期较完成3个周期(χ^(2)=8.79,P=0.003)和4个周期(χ^(2)=8.92,P=0.003)者差,完成3和4个周期诱导化疗患者预后差异无统计学意义,P>0.05。降期患者中,T和N降期者3年总生存率为81.2%(95%CI=0.76~0.88)和95.5%(95%CI=0.86~0.99),差异有统计学意义,χ^(2)=3.59,P=0.015;5年总生存率为64.7%(95%CI=0.59~0.69)和90.3%(95%CI=0.86~0.94),差异有统计学意义,χ^(2)=3.07,P=0.013。结果提示N降期患者预后更好。生存预�Objective To investigate the effect of neoadjuvant chemotherapy(NACT)intensity and the clinical stage decline after chemotherapy on the prognosis of nasopharyngeal carcinoma.Methods From October 2009 and October 2012,226 patients with initially diagnosed nasopharyneal carcinoma who were received NACT(docetaxel+cisplatin,TP)were analyzed.Before radical radiotherapy,2-4 cycles of neoadjuvant chemotherapy were performed,and after chemotherapy,Imaging examination(CT/MRI)to evaluate the effect and reassess clinical staging,then divided into down-stage patients group(196 patients)and non-down-stage patients group(30 patients).Different radical radiotherapy plans were formulated according to the staging conditions,after completion of all scheduled and follow-up by registered,SPSS 20.0 for statistical analysis using the clinical follow-up data,survival curves were plotted by Kaplan-Meier.Results All patients 3-year overall survival rates was 88.1%(95%CI=0.76-0.89),5-year overall survival rates was 75.4%(95%CI=0.69-0.78),the median survival was 67 months;The patients with declined clinical stage total 196 cases and 30 cases were not after neoadjuvant chemotherapy.All of the patients completion of radiation therapy and follow-up results showed that 3-years overall survival rates were 91.0%(95%CI=0.89-0.93)and 69.5%(95%CI=0.66-0.72,P=0.005),5-year overall survival rates were 81.6%(95%CI=0.78-0.86)and 53.3%(95%CI=0.49-0.61,P=0.001)respectively in declining clincal and undescended stage of the groups;The median survival of the two groups was 68 and 45 months;The 3-year failure-free survival rate were 84.6%(95%CI=0.76-0.88)and 62.7%(95%CI=0.59-0.68,P=0.008),5-year failure-free survival rate 76.5%(95%CI=0.71-0.89)and 42.6%(95%CI=0.40-0.51,P=0.007);3-year local recurrence-free survival rate were 95.0%(95%CI=0.90-0.98)and 82.3%(95%CI=0.78-0.87,P=0.010);5-year local recurrence-free survival rate were 82.3%(95%CI=0.77-0.89)and 43.2%(95%CI=0.39-0.48,P=0.002).Statistical analysis of different chemotherapeutic cycles showed that patie

关 键 词：鼻咽癌 新辅助化疗 再分期 联合放疗 

分 类 号：R739.6[医药卫生—肿瘤]