脑膜旁与非脑膜旁头颈部横纹肌肉瘤:一项基于倾向评分匹配与生存分析的研究  

Parameningeal or non-parameningeal head and neck rhabdomyosarcoma:a study based on propensity score matching and survival analysis

作　　者：陶吟杰 甄宏楠 管慧[1] 沈晶[1] 张福泉[1] 刘志凯[1] Tao Yinjie;Zhen Hongnan;Guan Hui;Shen Jing;Zhang Fuquan;Liu Zhikai(Department of Radiation Oncology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院放疗科,北京100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2022年第12期1409-1417,共9页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的基于倾向评分匹配(PSM)比较脑膜旁横纹肌肉瘤(rhabdomyosarcoma,RMS)与非脑膜旁RMS的生存差异,同时探讨影响头颈部横纹肌肉瘤(head and neck rhabdomyosarcoma,HNRMS)患者总生存率的影响因素。方法回顾分析北京协和医院2016年1月至2020年5月共64例经病理确诊为HNRMS的患者,其中男性31例,女性33例,年龄(8.0±8.9)岁。根据基线特征差异分为不同亚组并用Kaplan-Meier法绘制并比较生存曲线,按照原发部位是否靠近脑膜旁,分为非脑膜旁组(27例)与脑膜旁组(37例),通过1∶1 PSM,筛选出2组患者进一步分析,比较匹配前后临床基本资料以及2组总生存期(overall survival,OS)差异,并使用单因素与多因素Cox等比例风险回归模型探讨影响患者预后的因素。结果在64例HNRMS患者中,M0分期、危险分层较低、TNM分期较低均提示了较好的总生存率(P值均<0.05),匹配前脑膜旁RMS患者具有更高的T分期及术后美国横纹肌肉瘤研究组(Intergroup Rhabdomyosarcoma Study,IRS)分期(P值均<0.05),匹配后2组间基线数据无显著差异,匹配后脑膜旁组与非脑膜旁组患者的1、2、3年总生存率差异无统计学意义(P值均>0.05);肿瘤大小<5 cm、病理分型为胚胎型、FOXO1融合基因阴性、危险分层较低、TNM分期较低是总生存率的影响因素(P值均<0.05),其中肿瘤大小与病理分型是预后的独立影响因素(HR=2.36,95%CI:1.07~5.20,P=0.033;HR=5.54,95%CI:1.18~25.95,P=0.030)。结论与主流观点不同,本研究未发现头颈部脑膜旁与非脑膜旁RMS的预后差异;肿瘤大小<5 cm、病理分型为胚胎型提示患者有较好的总生存率。Objective To compare the prognoses between parameningeal and non-parameningeal head and neck rhabdomyosarcoma based on propensity score matching and to explore the prognostic factors of overall survival in patients with head and neck rhabdomyosarcoma.Methods The medical records of 64 patients with pathologically diagnosed as head and neck rhabdomyosarcoma from January 2016 to May 2020 in Peking Union Medical College Hospital were retrospectively retrieved,including 31 males and 33 females,with an average age of(8.0±8.9)years.Kaplan-Meier method was used to draw and compare survival curves in subgroup analysis according to different histopathological characteristics.Patients were divided into non-parameningeal(27 cases)and parameningeal(37 cases)group based on the location of primary lesion.Patients were further selected using 1∶1 propensity score matching method.The basic clinical data and overall survival were compared before and after matching.Prognostic factors were anlysed using Cox′s proportional hazards regression model.Results In 64 patients with head and neck rhabdomyosarcoma,lower risk stratification,and lower TNM stage indicated higher overall survival(all P<0.05).Before matching,patients in parameningeal group presented with higher T stage and IRS(Intergroup Rhabdomyosarcoma Study)staging(all P<0.05).There were no significant differences in basic clinical data and 1-,2-,and 3-year overall survival rates between two groups after matching(P>0.05).Tumor size smaller than 5 cm,embryonal histology,negative FOXO1 fusion gene,lower risk stratification,and lower TNM stage were associated with higher overall survival(all P<0.05).Among these,tumor size and histology were independent prognostic factors(HR=2.36,95%CI:1.07-5.20,P=0.033;HR=5.54,95%CI:1.18-25.95,P=0.030).Conclusions There is no significant difference in overall survival between patients with parameningeal and non-parameningeal rhabdomyosarcomas.Tumor size smaller than 5 cm and embryonal histology are two independent prognostic factors.

关 键 词：头颈部肿瘤 横纹肌肉瘤 脑膜旁 倾向评分匹配 预后 

分 类 号：R739.91[医药卫生—肿瘤]