调强放疗鼻咽癌患者UICC第7版与第8版T分期预后差异  

Prognostic differences of nasopharyngeal carcinoma patients treated with intensity-modulated radiothe-rapy with different T staging of the seventh and eighth edition of the UICC staging system

作　　者：陈方明 蔡园园[2] 李晗 王晓丽[2] 阚红星 李洋 郝福荣[2] 王明臣[2] Chen Fangming;Cai Yuanyuan;Li Han;Wang Xiaoli;Kan Hongxing;Li Yang;Hao Furong;Wang Mingchen(Department of Radiation Oncology,Rongcheng People's Hospital of Weihai City of Shandong Province,Weihai 264300,China;Department of Radiation Oncology,Weifang People's Hospital of Shandong Province,Weifang Key Laboratory of Radiophysics and Oncological Radiobiology,Weifang 261041,China;Department of Oncology,Fourth People's Hospital of Zibo City of Shandong Province,Zibo 255022,China;Department of Radiation Oncology,Yantai Yuhuangding Hospital of Shandong Province,Yantai 264001,China)

机构地区：[1]山东省威海市荣成市人民医院放疗科,264300 [2]山东省潍坊市人民医院放疗科潍坊市放射物理与肿瘤放射生物学重点实验室,261041 [3]山东省淄博市第四人民医院肿瘤科,255022 [4]山东省烟台毓璜顶医院放疗科,264001

出　　处：《国际肿瘤学杂志》2021年第9期515-522,共8页Journal of International Oncology

基　　金：潍坊市科技发展计划(2019YX003)。

摘　　要：目的比较调强放疗鼻咽癌在国际抗癌联盟(UICC)鼻咽癌第7版(简称UICC 7版)与第8版(简称UICC 8版)T分期的人群分布和预后差异,并分析鼻咽癌患者的预后影响因素。方法回顾性分析2005年6月1日至2017年12月31日山东省潍坊市人民医院放疗科收治的184例初治调强放疗鼻咽癌患者的临床病理资料,按UICC 7版、UICC 8版对入组病例进行重新分期,分析两版分期系统患者T分期的分布,采用Kappa一致性检验比较两种分期的一致性。采用Kaplan-Meier法进行生存分析,log-rank检验比较各T分期之间的预后差异。采用Cox回归模型分析鼻咽癌患者的预后影响因素。结果184例调强放疗鼻咽癌患者按UICC 7版T分期,T_(1)、T_(2)、T_(3)和T_(4)期分别占18.5%(34/184)、16.8%(31/184)、15.2%(28/184)、49.5%(91/184),而按UICC 8版T分期,分别占18.5%(34/184)、34.2%(63/184)、30.4%(56/184)和16.8%(31/184),两版分期系统的T分期人群分布具有中度一致性(Kappa=0.58)。UICC 7版分期中,T_(1)、T_(2)、T_(3)、T_(4)期患者的总生存期(OS)差异有统计学意义(χ^(2)=10.606,P=0.014),T_(1)与T_(2)、T_(3)、T_(4)期患者的OS差异均有统计学意义(χ^(2)=4.866,P=0.027;χ^(2)=11.965,P=0.001;χ^(2)=4.351,P=0.037),T_(2)、T_(4)期OS曲线不能分离,T_(3)、T_(4)期OS曲线倒序分布;UICC 8版分期中,4期患者的OS差异有统计学意义(χ^(2)=8.663,P=0.034),T_(1)与T_(3)、T_(4)期患者的OS差异均有统计学意义(χ^(2)=8.746,P=0.003;χ^(2)=7.580,P=0.006),T_(1)~T_(4)期的OS曲线顺序分布,T_(3)与T_(4)期OS曲线仍未能分离。UICC 7版分期中,T_(1)、T_(2)、T_(3)、T_(4)期患者的无进展生存期(PFS)差异有统计学意义(χ^(2)=11.289,P=0.010),T_(1)与T_(2)、T_(3)、T_(4)期患者的PFS差异均有统计学意义(χ^(2)=8.209,P=0.004;χ^(2)=13.302,P<0.001;χ^(2)=6.550,P=0.010),T_(2)、T_(4)期PFS曲线不能分离,T_(3)、T_(4)期PFS曲线倒序分布;UICC 8版分期中,4期患者的PFS差异有统计学意义(χ^(2)=12.074,P=Objective To compare the differences in population distribution and prognosis of patients with nasopharyngeal carcinoma(NPC)treated with intensity-modulated radiotherapy(IMRT)in T staging of the Union for International Cancer Control(UICC)7th edition and UICC 8th edition,and to analyze the prognostic factors in patients with NPC.Methods The clinicopathologic date of 184 patients with newly diagnosed NPC treated with IMRT at the Department of Radiation Oncology of Weifang People's Hospital of Shandong Province from June 1,2005 to December 31,2017 were retrospectively analyzed.All patients were restaged according to the 7th and 8th edition of the UICC staging system.The distribution of T staging of patients in the two staging systems was analyzed,and the consistency of the two staging systems was compared using the Kappa consistency test.Kaplan-Meier method was used for survival analysis,and log-rank test was used to compare the prognostic differences among T stages.Cox regression model was used to analyze the prognostic factors of patients with NPC.Results Of all 184 patients with NPC,stage T_(1),T_(2),T_(3) and T_(4) respectively accounted for 18.5%(34/184),16.8%(31/184),15.2%(28/184)and 49.5%(91/184)according to the 7th edition UICC staging system.However,stage T_(1),T_(2),T_(3) and T_(4) respectively accounted for 18.5%(34/184),34.2%(63/184),30.4%(56/184)and 16.8%(31/184)according to the 8th edition UICC staging system.The T staging population distribution of the two staging systems showed moderate consistency(Kappa=0.58).There was a statistically significant difference in overall survival(OS)among patients with stage T_(1),T_(2),T_(3),T_(4) according to the 7th edition UICC staging system(χ^(2)=10.606,P=0.014).There were statistically significant differences in OS between stage T_(1) and stage T_(2),T_(3),T_(4)(χ^(2)=4.866,P=0.027;χ^(2)=11.965,P=0.001;χ^(2)=4.351,P=0.037).The OS curves of stage T_(2) and T_(4) could not be separated.Moreover,the OS curves of stage T_(3) and T_(4) were distributed in revers

关 键 词：鼻咽肿瘤 放射疗法 肿瘤分期 预后 

分 类 号：R739.63[医药卫生—肿瘤]