The study of clinical long-term effect and prognostic factors in nasopharyngeal carcinoma after intensity modulated radiation therapy
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摘要: 目的:回顾性分析137例鼻咽癌调强适形放射治疗的远期疗效及预后影响因素。方法:对确诊的初治的无远处转移的137例鼻咽癌患者,采用三维适形调强放射治疗技术。在放疗后1个月按WHO实体瘤疗效评价标准进行近期疗效评价。放疗结束后2年内每3个月复查一次,2年后每6~12个月复查一次,常规进行临床查体、鼻咽镜、CT、B超、MRI、胸片、骨扫描检查,了解鼻咽腔、颈部淋巴结及颅神经情况。采用寿命表法计算总生存率,Kaplan-Meier方法计算无复发生存率、无远处转移生存率、无瘤生存率,用Log-rank检验法对14项可能影响预后的临床因素进行单因素分析,采用 Cox 风险比例模型做多因素分析,P<0.05为差异有统计学意义。结果:①1、3、5年总生存率分别为98.5%、90.3%、74.6%,无复发生存率分别为97.0%、81.9%、66.7%无远处转移生存率分别为96.3%、80.5%、56.0%,无瘤生存率分别为95.6%、76.9%、43.8%;②单因素分析显示T分期、N分期、92福州临床分期、联合化疗、颅底骨质破坏、颅神经损伤、咽后淋巴结转移、疗终残留、总放疗时间等对预后的影响有统计学意义(均P<0.05);性别、族别、年龄、病理类型、贫血与否对预后的影响无统计学意义(均P>0.05);③将T分期、颅底骨质破坏、颅神经损伤、咽后淋巴结转移、N分期、联合化疗、疗终残留、总放疗时间、贫血与否引入Cox模型,结果表明N分期、联合化疗、颅神经损伤、疗终残留、总放疗时间是影响鼻咽癌预后的独立因素(均P<0.05)。结论:鼻咽癌调强适形放射治疗较常规放疗有明显优势,在相关临床因素中N分期、颅神经损伤、联合化疗、疗终残留、总放疗时间是影响预后的最主要因素。Abstract: Objective: To retrospectively analyze the long-term curative effects and prognostic factors of 137 cases of NPC patients treated with intensity modulated radiation therapy.Method: The three-dimensional conformal intensity modulated radiation therapy adopted for the design plan of 137 cases of newly diagnosed and no distant metastatic NPC patients.Evaluation of short-term clinical efficacy was made according to the efficacy evaluation criteria of WHO solid tumor one month after radiotherapy. During the 2 years after radiotherapy, re-examinations were made every 3 months. Two years later, re-examinations were made every 6 to 12 months, and the routine examinations included clinical body check, nasopharyngoscope, CT, B Chao, MRI, chest X-ray, bone scan, so as to understand the condition of cavum nasopharyngeum, cervical lymph nodes and cranial nerves. Life table method was adopted to calculate the overall survival rate, Kaplan-Meier method was used to calculate relapse-free survival rate, distant metasis-free survival rate and disease-free survival rate. Log-rank test was used for univariate analysis of 14 clinical factors which may exert influences on prognosis. Multivariate analysis was performed with the Cox regression model,P<0.05 is of statistical significance.Result: ①Of the 137 cases, the overall survival rates of 1-year, 3-year and 5-year were 98.5%, 90.3%, 74.6% respectively, relapse-free survival rates were 97.0%, 81.9%, 66.7% respectively; distant metasis-free survival rates were 96.3%, 80.5%, 56.0% respectively; disease free survival rates were 95.6%, 76.9%, 43.8% respectively. ②Univariate analysis revealed that the influences of T-staging,N-staging, 92 Fuzhou clinical staging, combined chemotherapy, skull base bone destruction,injury of cranial nerve, retropharyngeal lymph node metastasis, residual disease, total time of IMRT on prognosis were of no statistical significance(with all the P values lower than 0.05) The influences of gender, nationality, age, pathological type and anemia or on prognosis were of no statistical significance(with all the P values higher than 0.05).③T-staging, skull base bone destruction, injury of cranial nerve, retropharyngeal lymph node metastasis, N-staging, combined chemotherapy, residual disease, total time of IMRT, and anemia were drawn into Cox model, and the results showed that N-staging, combined chemotherapy, injury of cranial nerve, residual disease, and total time of IMRT were independent factors that affect prognosis(with all P values lower than 0.05).Conclusion: IMRT obviously has advantages than conventional radiotheraphy in treating NPC patients. N-staging, injury of cranial nerve, combined chemotherapy, residual disease, and total time of IMRT are the main factors that affect prognosis.
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