初治转移鼻咽癌疗后预后评分模型建立及分层治疗研究

doi:10.3760/cma.j.issn.1004-4221.2015.04.017

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摘要目的建立初治转移鼻咽癌疗后预后评分模型,探讨其分层治疗的可行性。方法 2002—2010年共263例符合入组条件的初治鼻咽癌转移患者纳入研究。原发灶主要包括常规放疗、3DCRT、IMRT等,照射范围包括鼻咽病灶+颈部淋巴引流区。骨转移病灶的处理主要是常规外放疗,肝、肺等主要选择手术切除、放疗及射频消融处理等。大部分患者一线治疗均采用以顺铂为基础的联合化疗方案。将患者一般特点、肿瘤状态以及治疗相关因素等纳入多因素分析,根据预后因素n值(其中HR=eⁿ)建立预后模型。结果影响患者OS因素包括KPS≤70(P=0.00)、联合器官转移(P=0.00)、合并肝转移(P=0.00)、转移数目≥2个(P=0.00)、LDH>245 IU/I (P=0.00)、化疗周期数1~3个(P=0.00)、转移灶疗效为SD或PD (P=0.00)、原发灶未接受放疗(P=0.01)。根据患者预后评分分为低危组(0~1.5分)、中危组(2.0~6.5分)、高危组(≥7.0分),5年OS率分别为59.0%、25.1%、0(P=0.00)。结论基于患者KPS、血清LDH水平及联合脏器转移、合并肝转移、转移数目建立的预后评分模型能有效预测患者生存,积极的治疗方式包括≥4个周期化疗和原发灶放疗等能提高低、中危组患者生存时间;而对高危组患者原发灶放疗不能带来生存获益,以姑息性化疗为主。

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	蓝玉宏
	田允铭
	白力
	曾雷
	肖巍魏
	卢泰祥
	韩非

关键词 ：鼻咽肿瘤, 转移/放射疗法, 鼻咽肿瘤, 转移/化学疗法, 预后评分模型

Abstract：Objective To establish a post-treatment prognostic score model for newly diagnosed metastatic nasopharyngeal carcinoma, and to investigate the feasibility of stratified therapy. Methods A total of 263 eligible patients with newly diagnosed metastatic nasopharyngeal carcinoma from 2002 to 2010 were enrolled as subjects. The primary tumor was treated with conventional radiotherapy, three-dimensional conformal radiotherapy, or intensity-modulated radiotherapy, and radiation areas included nasopharyngeal tumor and cervical lymphatic drainage region. The metastatic bone tumor was mainly treated with conventional external radiotherapy, while the metastatic liver or lung tumor was mainly treated with surgical resection, radiotherapy, or radiofrequency ablation. The first-line therapy for most of patients was cisplatin-based combination chemotherapy. Factors including the general characteristics, tumor status, and therapy for patients were involved in multivariate analysis, and a prognostic model was established based on the n value (HR=eⁿ) of the prognostic factors. Results The factors influencing the overall survival (OS) in patients were a Karnofsky performance score (KPS) not higher than 70(P=0.00), multiple organ metastases (P=0.00), combination with liver metastasis (P=0.00), a number of metastases not less than 2(P=0.00), a level of lactate dehydrogenase (LDH) higher than 245 IU/L (P=0.00), a number of chemotherapy cycles ranging between 1 and 3(P=0.00), a poor response for metastatic tumor (stable disease or progressive disease)(P=0.00), and primary tumor not treated with radiotherapy (P=0.01). Based on the prognostic score, patients were divided into low-risk group (0-1.5 points), intermediate-risk group (2.0-6.5 points), and high-risk group (≥7.0 points), and the 5-year OS rates in the three groups were 59.0%, 25.1%, and 0%, respectively. Conclusions The prognosticscore model based on the KPS, serum level of LDH, multiple organ metastases, combination with liver metastasis, and number of metastases can effectively predict the survival in patients. Active treatment including at least 4 chemotherapy cycles and radiotherapy for primary tumor can prolong the survival time of patients in the low-and intermediate-risk groups. However, patients in the high-risk group were mainly treated with palliative radiotherapy due to no improvement in the survival by radiotherapy for primary tumor.

Key words： Nasopharyngeal neolasms,metastasis/radiotherapy Nasopharyngeal neolasms,metastasis/chemotherapy Prognostic-score model

收稿日期: 2014-11-07

通讯作者: 田允铭,Emailtianyunming123@126.com;韩非,Emailhanfei@sysucc.org.cn

引用本文:

蓝玉宏,田允铭,白力等. 初治转移鼻咽癌疗后预后评分模型建立及分层治疗研究[J]. 中华放射肿瘤学杂志, 2015, 24(4): 421-426.

Lan yuhong^*,Tian Yunming,Bai Li et al. Post-treatment prognostic score model establishment and stratified therapy for newly diagnosed metastatic nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2015, 24(4): 421-426.

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[1] Yu MC, Yuan JM. Epidemiology of nasopharyngeal carcinoma[J]. Semin Cancer Biol,2002,12(6):421-429.
[2] Chang ET, Adami HO. The enigmatic epidemiology of nasopharyngeal carcinoma[J]. Cancer Epidemiol Biomarkers Prev,2006,15(10):1765-1777.
[3] Lee AW, Ng WT, Chan YH, et al. The battle against nasopharyngeal cancer[J]. Radiother Oncol,2012,104(3):272-278.DOI:10.1016/j.radonc.2012.08.001.
[4] Yeh SA, Tang Y, Lui CC, et al. Treatment outcomes of patients with AJCC stage ⅠVC nasopharyngeal carcinoma:benefits of primary radiotherapy[J]. Jpn J Clin Oncol,2006, 36(3):132-136.
[5] 王成涛,曹卡加,李茵,等.鼻咽癌远处转移的预后分析[J].癌症,2007,26(2):212-215.
[6] 韩露,林少俊,李夷民,等.46例首诊伴远处转移鼻咽癌的预后分析[J].中华放射肿瘤学杂志,2009,18(3):170-172.DOI:10.3760/cma.j.issn.1004-4221.2009.03.170.
[7] Teo PM, Kwan WH, Lee WY, et al. Prognosticators determining survival subsequent to distant metastasis from nasopharyngeal carcinoma[J]. Cancer,1996,77(12):2423-2431.
[8] Khanfir A, Frikha M, Ghorbel A, et al. Prognostic factors in metastatic nasopharyngeal carcinoma[J]. Cancer Radiother,2007,11(8):461-464.
[9] Setton J, Wolden S, Caria N, Lee N. Definitive treatment of metastatic nasopharyngeal carcinoma:Report of 5 cases with review of literature[J]. Head Neck,2012, 34(5):753-757.DOI:10.1002/hed.21608.
[10] Hui EP, Leung SF, Au JS, et al. Lung metastasis alone in nasopharyngeal carcinoma:a relatively favorable prognostic group. A study by the Hong Kong nasopharyngeal carcinoma study group[J]. Cancer,2004,101(2):300-306.
[11] Ong YK, Heng DM, Chung B, et al. Design of a prognostic index score for metastatic nasopharyngeal carcinoma[J]. Eur J Cancer,2003,39(11):1535-1541.
[12] Tian YM, Zeng L, Wang FH, et al. Prognostic factors in nasopharyngeal carcinoma with synchronous liver metastasis:a retrospective study for the management of treatment[J]. Radiat Oncol,2013,8(1):272.DOI:10.1186/1748-717X-8-272.
[13] Paesmans M, Sculier JP, Libert P, et al. Prognostic factors for survival in advanced non-small-cell lung cancer:univariate and multivariate analyses including recursive partitioning and amalgamation algorithms in 1,052 patients[J]. J Clin Oncol,1995,13(5):1221-1230.
[14] Polee MB, Hop WC, Kok TC, et al. Prognostic factors for survival in patients with advanced oesophageal cancer treated with cisplatin-based combination chemotherapy[J]. Br J Cancer,2003,89(11):2045-2050.
[15] Koukourakis MI, Giatromanolaki A, Sivridis E, et al. Tumour and Angiogenesis Research Group. Lactate dehydrogenase-5(LDH-5) over expression in non-small-cell lung cancer tissues is linked to tumour hypoxia, angiogenic factor production and poor prognosis[J]. Br J Cancer,2003,89(5):877-885.
[16] Liaw CC, Wang CH, Huang JS,et al. Serum lactate dehydrogenase level in patients with nasopharyngeal carcinoma[J]. Acta Oncol,1997,36(2):159-164.
[17] Zhou GQ, Tang LL, Mao YP, et al. Baseline serum lactate dehydrogenase levels for patients treated with intensity-modulated radiotherapy for nasopharyngeal carcinoma:a predictor of poor prognosis and subsequent liver metastasis[J]. Int J Radiat Oncol Biol Phys,2012,82(2):359-365.
[18] Hellman S, Weichselbaum RR. Oligometastases[J]. J Clin Oncol,1995,13(1):8-10.
[19] Fong Y, Cohen AM, Fortner JG, et al. Liver resection for colorectal metastases[J]. J Clin Oncol,1997,15(3):938-946.
[20] Salama JK, Milano MT. Radical Irradiation of Extracranial Oligometastases[J]. J Clin Oncol, 2014,32(26):2902-2912.
[21] Fandi A, Bachouchi M, Azli N, et al. Long-term disease-free survivors in metastatic undifferentiated carcinoma of nasopharyngeal type[J].J Clin Oncol,2000,18(8):1324-1330.