诱导化疗周期数对局部晚期鼻咽癌患者生存结局的影响  

Effect of the number of cycles of induction chemotherapy on survival outcomes in patients with locally advanced nasopharyngeal carcinoma

作　　者：宁婷婷 胡钦勇[1] 黄华玉 刘文敏 李倩[1] NING Tingting;HU Qinyong;HUANG Huayu;LIU Wenmin;LI Qian(Cancer Center,Renmin Hospital of Wuhan University Wuhan,430060,Hubei,China)

机构地区：[1]武汉大学人民医院肿瘤中心,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2024年第3期291-297,共7页Medical Journal of Wuhan University

基　　金：国家自然科学基金资助项目(编号:81670144)。

摘　　要：目的:评估不同周期诱导化疗(IC)对局部晚期鼻咽癌(LA-NPC)患者的疗效。方法:回顾性分析武汉大学人民医院2016年1月—2021年8月接受IC联合同期放化疗(CCRT)治疗的LA-NPC患者,根据IC周期分为IC<3组和IC≥3组。用t检验和χ2检验分析组间差异,采用Kaplan-Meier法及log-rank检验比较两组的生存结局,单变量和多变量Cox回归模型以确定潜在的独立预测因素,并进行亚组分析来探讨补充辅助化疗(AC)能否提高IC联合CCRT治疗LA-NPC的疗效。结果:共纳入138例LA-NPC患者(IC<3组92例、IC≥3组46例)。中位随访时间为31.2个月。IC<3组1、3年无远处转移生存率(DMFS)显著优于IC≥3组(分别为86.9%vs 74.6%和86.9%vs 64.5%,P<0.01)。亚组分析结果显示,在IC<3组中,IC联合CCRT后序贯AC可进一步改善患者的DMFS(1年:94.4%vs 75.0%;3年:91.6%vs 70.0%,P<0.01)。多因素分析显示IC周期为DMFS的独立影响因素。结论:IC周期是LA-NPC的独立预后因素,与≥3周期IC相比,接受<3周期的IC可减少远处转移的发生;当患者接受<3周期IC联合CCRT后序贯AC可进一步提高患者的DMFS。Objective:To evaluate the efficacy of different cycles of induction chemotherapy(IC)in patients with locoregionally advanced nasopharyngeal carcinoma(LA‑NPC).Methods:We retrospectively an‑alyzed LA‑NPC patients treated with IC combined with concurrent chemoradiotherapy(CCRT)in Re‑min Hospital of Wuhan University from January 2016 to August 2021.They were divided into the IC<3 group and IC≥3 group according to IC cycles.T‑tests andχ2‑tests were used to analyze the dif‑ferences between groups,Kaplan‑Meier and log‑rank tests were adopted to compare the survival out‑comes,univariate and multivariate Cox regression models were adopted to identify potential indepen‑dent predictors,and subgroup analyses were used to investigate whether complementary adjuvant che‑motherapy(AC)could improve the efficacy of IC combined with CCRT for LA‑NPC.Results:A to‑tal of 138 patients with LA‑NPC were included(92 in the IC<3 group and 46 in the IC≥3 group).The median follow‑up time was 31.2 months,and the 1‑and 3‑year distant metastasis‑free survival(DMFS)rates were significantly higher in the IC<3 group than in the IC≥3 group(86.9%vs 74.6%and 86.9%vs 64.5%,respectively,P<0.01).Subgroup analysis showed that sequential AC after IC combined with CCRT further improved patients'DMFS in the IC<3 group(1 year:94.4%vs 75.0%;3 years:91.6%vs 70.0%,P<0.01).Multifactorial analysis showed that the IC cycle was an independent factor for DMFS.Conclusion:IC cycle is an independent prognostic factor for LA‑NPC,and receiving<3 cycles IC reduces the incidence of distant metastases as compared with≥3 cycles IC;sequential AC further improves patients'DMFS when they receive<3 cycles IC com‑bined with CCRT.

关 键 词：局部晚期鼻咽癌 诱导化疗 周期数 辅助化疗 生存 

分 类 号：R739.63[医药卫生—肿瘤]