IMRT时代鼻咽癌临床分期的降期新建议研究

doi:10.3760/cma.j.issn.1004-4221.2017.06.002

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摘要目的在不改变目前T、N、M分期定义基础上,提出适用于IMRT时代鼻咽癌临床分期的降期新建议。方法回顾分析中山大学附属肿瘤医院2002—2006年536例鼻咽癌病例,采用Kaplan-Meier计算DSS率并Logrank检验,Cox法计算各亚组DSS风险比。结果依据第7版UICC/AJCC分期系统,Ⅰ—Ⅲ期非T₃N₂M₀期患者5年DSS均在85%以上,Ⅳ_A、Ⅳ_B期的分别为71.8%、46.2%(P=0.171),而Ⅳ_C期的仅为24.0%。Ⅲ期患者中非T₃N₂M₀期患者5年DSS (91.5%)高于T₃N₂M₀期患者(78.6%)(P=0.042)。T₃N₂M₀期患者DSS经临床综合评估与Ⅳ_A—Ⅳ_B期患者相似。新Ⅰ期包括T_1-3N_0-1M₀和T_1-2N₂M₀,新Ⅱ期包括T₃N₂M₀、T₄N_0-2M₀和 TxN₃M₀期,新Ⅲ期包括TxNxM₁期,新Ⅰ、Ⅱ、Ⅲ期的5年DSS分别为93.3%、72.7%、24.0%(P=0.000),相比于新Ⅰ期,新Ⅱ、Ⅲ期的5年DSS风险比分别为4.01、16.76。结论 IMRT时代把鼻咽癌临床分期降为3个组可以更好地区分预后及指导临床治疗。

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关键词 ：鼻咽肿瘤/调强放射疗法, 降期, 新建议

Abstract： Objective To propose a new suggestion for the clinical downstaging of nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT) without changing the current T,N,and M staging system. Methods We reviewed the records of 536 NPC patients treated in Sun Yat-Sen University Cancer Center from January 2002 to December 2006.The Kaplan-Meier method was used to calculate the disease-specific survival (DSS) rate,and the log-rank test was used for survival differenceanalysis. The Cox regression model was used to calculate the hazard ratio (HR) of each subset. ResultsAccording to the 7^th edition of UICC/AJCC staging system,the 5-year DSS rates of stage Ⅰ-Ⅲ patients (except T₃N₂M₀) were all more than 85%(P>0.05),those of stage Ⅳ_A and Ⅳ_B patients were 71.8% and 46.2%,respectively (P=0.171),and that of stage ⅠVC patients was only 24.0%.In stage Ⅲ,the 5-year DSS rate of non-T₃N₂M₀ patients (91.5%) was significantly higher than that of T₃N₂M₀ patients (78.6%)(P=0.042),but there was no significant difference in DSS between T₃N₂M₀ patients and stage Ⅳ_A and Ⅳ_B patients. Based on the above results,new stage Ⅰ included T_1-3N_0-1M₀ and T_1-2N₂M₀,new stage Ⅱ included T₃N₂M₀,T₄N_0-2M₀,and TxN₃M₀,and new stage Ⅲ included TxNxM₁.The 5-year DSS rates of new stage Ⅰ,Ⅱ,and Ⅲ patients were 93.3%,72.7%,and 24.0%,respectively (P=0.000).Compared with new stage Ⅰ patients,new stage Ⅱ and Ⅲ patients had HRs of 4.01 and 16.76,respectively,for 5-year DSS. Conclusions In the era of IMRT,the new clinical staging system (stages Ⅰ,Ⅱ,and Ⅲ) helps with prognostic evaluation and clinical treatment.

Key words：　Nasopharyngeal neoplasms/intensity modulated radiotherapy Down-staging New suggestion

收稿日期: 2016-11-04

基金资助:国家863计划(2006AA02Z4B4);国家自然科学基金(31170805)

通讯作者: 夏云飞,Email:xiayf@sysucc.org.cn

引用本文:

. IMRT时代鼻咽癌临床分期的降期新建议研究[J]. 中华放射肿瘤学杂志, 2017, 26(6): 614-620.

. New suggestion for clinical downstaging of nasopharyngeal carcinoma in the era of intensity-modulated radiotherapy[J]. Chinese Journal of Radiation Oncology, 2017, 26(6): 614-620.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2017.06.002 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2017/V26/I6/614

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