Abstract Objective To analyze the prognostic impact of degree of bone metastasis in patients with nasopharyngeal carcinoma (NPC) after radiochemotherapy. Methods A retrospective analysis was performed on the prognosis of 109 NPC patients who had bone metastases after radiochemotherapy in Nanfang Hospital from June 1997 to December 2007. The Kaplan-Meier method was used to calculate survival rates;the log-rank test was used for univariate prognostic analysis;the Cox regression model was used for multivariate prognostic analysis. Results The 5-year follow-up rate was 97.2%. The 1-, 2-, 3-, and 5-year overall survival rates for all patients were 67.9%, 48.6%, 32.9%, and 17.4%, respectively. The 1-, 2-, 3-, and 5-year survival rates for the 43 patients with not more than 3 bone metastases and the 66 patients with more than 3 bone metastases were 90.7% vs. 53.0%, 81.4% vs. 27.3%, 72.1% vs. 6.2%, and 34.9% vs. 4.2%, respectively (P=0.000). In the patients with more than 3 bone metastases, the 1-, 2-, 3-, and 5-year survival rates for those with and without other metastatic sites were 56.5% vs. 72.1%, 21.7% vs. 30.2%, 3.1% vs. 13.0%, and 0.0% vs. 6.5%, respectively (P=0.866). The multivariate analysis showed that more than 3 bone metastases were an adverse prognostic factor in the patients (P=0.000). Conclusions The number of bone metastases is an important prognostic factor in NPC patients after radiochemotherapy. Patients with not more than 3 bone metastases have better survival than those with more than 3 bone metastases, and aggressive treatment should be considered. In addition, the staging system of NPC needs to be improved.
ZHU Yan-fe,DING Yi,CHEN Bin et al. Prognostic impact of degree of bone metastasis in patients with nasopharyngeal carcinoma after radiochemotherapy[J]. Chinese Journal of Radiation Oncology, 2013, 22(4): 299-301.
ZHU Yan-fe,DING Yi,CHEN Bin et al. Prognostic impact of degree of bone metastasis in patients with nasopharyngeal carcinoma after radiochemotherapy[J]. Chinese Journal of Radiation Oncology, 2013, 22(4): 299-301.
[1] Timmerman RD, Bizekis CS, Pass HI, et al. Local surgical, ablative, and radiation treatment of metastases. CA Cancer J Clin,2009,59:145-170. [2] Razak AR, Siu LL, Liu FF, et al. Nasopharyngeal carcinoma:the next challenges. Eur J Cancer,2010,46:1967-1978. [3] 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. Cancer,2004,101:300-306. [4] Lee AW, Sze WM, Au JS, et al. Treatment results for nasopharyngeal carcinoma in the modern era:the Hong Kong experience. Int J Radiat Oncol Biol Phys,2005,61:1107-1116. [5] Lee N, Xia P, Quivey JM, et al. Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma:an update of the UCSF experience. Int J Radiat Oncol Biol Phys,2002,53(1):12-22. [6] Gospodarowicz MK, Miller D, Groome PA, et al. The process for continuous improvement of the TNM classification. Cancer,2004,100:1-5. [7] Greene FL, Sobin LH. The staging of cancer:a retrospective and prospective appraisal. CA Cancer J Clin,2008,58:180-190. [8] Khanfir A, Frikha M, Ghorbel A, et al. Prognostic factors in metastatic nasopharyngeal carcinoma. Cancer Radiother,2007,11:461-464. [9] Lee N, Xia P, Quivey JM, et al. Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma:an update of the UCSF experience. Int J Radiat Oncol Biol Phys,2002,53:12-22. [10] Kam MK, Teo PM, Chau RM, et al. Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy:the Hong Kong experience. Int J Radiat Oncol Biol Phys,2004,60:1440-1450. [11] Lin S, Pan J, Han L, et al. Nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiation therapy:report on the 3-year outcome of a prospective series. Int J Radiat Oncol Biol Phys,2009,75:1071-1078. [12] Cao X, Han Y, He L, et al. Risk subset of the survival for nasopharyngeal carcinoma patients with bone metastases:who will benefit from combined treatment?. Oral Oncol,2011,47:747-752. [13] Ong YK, Heng DM, Chung B, et al. Design of a prognostic index score for metastatic nasopharyngeal carcinoma. Eur J Cancer,2003,39:1535-1541. [14] Lu X, Qian CN, Mu YG, et al. Serum CCL2 and serum TNF-alpha—two new biomarkers predict bone invasion, post-treatment distant metastasis and poor overall survival in nasopharyngeal carcinoma. Eur J Cancer,2011,47:339-346. [15] Sultanem K, Shu H, Xia P, et al. Three-dimensional intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma:the university of California-San Francisco experience. Int J Radiat Oncol Biol Phys,2000,48:711-722. [16] Pan C, He N, Zhao M, et al. Subdividing the M1 stage of liver metastasis for nasopharyngeal carcinoma to better predict metastatic survival. Med Oncol,2011,28:1349-1355. [17] Khanfir A, Frikha M, Ghorbel A, et al. Metastatic nasopharyngeal carcinoma:clinical study and therapeutic results of 95 cases. Cancer Radiother,2006,10:545-549. [18] Ma J, Mai HQ, Hong MH, et al. Results of a prospective randomized trial comparing neoadjuvant chemotherapy plus radiotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma. J Clin Oncol,2001,19:1350-1357. [19] 张瑜,林志安,潘建基,等.初治鼻咽癌调强放疗与常规放疗的同期对照研究.癌症,2009,28:1143-1148. [20] 周娟,张为民,陈海,等.171例转移性鼻咽癌患者的化疗疗效和预后因素分析.中华肿瘤杂志,2009,31:867-872. [21] Wee J, Tan EH, Tai BC, et al. Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American joint committee on cancer/international union against cancer stage Ⅲ and Ⅳ nasopharyngeal cancer of the endemic variety. J Clin Oncol,2005,23:6730-6738. [22] Baujat B, Audry H, Bourhis J, et al. Chemotherapy in locally advanced nasopharyngeal carcinoma:an individual patient data meta-analysis of eight randomized trials and 1753 patients. Int J Radiat Oncol Biol Phys,2006,64:47-56. [23] Chi KH, Chang YC, Guo WY, et al. A phase Ⅲ study of adjuvant chemotherapy in advanced nasopharyngeal carcinoma patients. Int J Radiat Oncol Biol Phys,2002,52:1238-1244. [24] Huncharek M, Kupelnick B. Combined chemoradiation versus radiation therapy alone in locally advanced nasopharyngeal carcinoma:results of a meta-analysis of 1,528 patients from six randomized trials. Am J Clin Oncol,2002,25:219-223. [25] Hu YC, Chang CH, Chen CH, et al. Impact of intracranial extension on survival in stage Ⅳ nasopharyngeal carcinoma:identification of a subset of patients with better prognosis. Jpn J Clin Oncol,2011,41:95-102. [26] Pan CC, Lu J, Yu JR, et al. Challenges in the modification of the M1 stage of the TNM staging system for nasopharyngeal carcinoma:a study of 1027 cases and review of the literature. Exp Ther Med,2012,4:334-338.
2013, Vol. 22 
