基于IMRT同步放化疗方案治疗局部晚期鼻咽癌不良预后危险因素及预测模型构建

Poor prognostic risk factors and prediction model construction of locally advanced nasopharyngeal carcinoma treated by concurrent chemoradiotherapy based on IMRT

目的探讨基于调强放疗(IMRT)同步放化疗方案治疗局部晚期鼻咽癌不良预后危险因素并构建预测模型,为临床诊疗方案优化及预后改善提供更多参考。方法收集2012年1月~2017年12月梅州市人民医院接受基于IMRT同步放化疗方案治疗局部晚期鼻咽癌患者190例,分析临床特征资料和随访生存情况,采用单因素和多因素评价患者不良预后独立危险因素;基于独立危险因素构建列线图模型并评价模型预后预测效能。结果190例患者随访过程中死亡26例,累积1年、3年及5年总生存率分别为97.4%、90.7%、87.0%。单因素分析结果显示,年龄、淋巴细胞与单核细胞绝对值比值、乳酸脱氢酶、颅底侵犯、N分级及辅助化疗情况均与局部晚期鼻咽癌不良预后有关,差异有统计学意义(P<0.05)。多因素分析结果显示,乳酸脱氢酶水平≥185 IU/L、颅底侵犯及N3均是局部晚期鼻咽癌不良预后独立危险因素(P<0.05)。将多因素分析有统计学意义指标纳入局部晚期鼻咽癌患者总生存时间列线图模型,患者总生存时间列线图模型用于累积1年、3年及5年总生存时间C-index为0.84(95%CI:0.72~0.86),总生存时间预测AUC分别为0.87(95%CI:0.75~0.93)、0.90(95%CI:0.79~0.96)、0.85(95%CI:0.80~0.98)。结论接受基于IMRT同步放化疗方案治疗局部晚期鼻咽癌患者不良预后可能与乳酸脱氢酶水平、有无颅底侵犯及N分级等密切相关,而根据上述预后因素构建线列图模型在预测患者随访总生存时间方面具有良好效能。

OBJECTIVE To investigate the poor prognostic risk factors of locally advanced nasopharyngeal carcinoma treated by concurrent chemoradiotherapy based on IMRT and construct prediction model in order to provides more reference for clinical diagnosis and treatment plan optimization and prognosis improvement.METHODS A total of 190 patients with locally advanced nasopharyngeal carcinoma treated by concurrent chemoradiotherapy based on IMRT were retrospectively studied in the period from January 2012 to December 2017 in our hospital.The clinical characteristics and follow-up survival were analyzed and the independent risk factors for poor prognosis were evaluated by univariate and multivariate methods.The linear graph model was constructed based on independent risk factors and the prognostic prediction efficiency of linear graph model was evaluated.RESULTS Twenty six cases in 190 patients were died during follow-up,and the cumulative 1-year,3-year and 5-year overall survival rates were 97.4%,90.7%and 87.0%respectively.Univariate analysis showed that age,absolute ratio of lymphocyte to monocyte,lactate dehydrogenase,invasion of skull base,N stage and adjuvant chemotherapy were all associated with poor prognosis of locally advanced nasopharyngeal carcinoma(P<0.05).Multivariate analysis showed that lactate dehydrogenase level≥185 IU/L,skull base invasion and N_3 stage were independent risk factors for poor prognosis of local advanced nasopharyngeal carcinoma(P<0.05).The clinical indexes with statistical significance in multivariate analysis were included in the overall survival time of patients with locally advanced nasopharyngeal carcinoma.The cumulative 1-year,3-year and 5-year survival c-index of patients with locally advanced nasopharyngeal carcinoma was 0.84(95%CI:0.72-0.86)and the predictive AUC of overall survival time were 0.87(95%CI:0.75-0.93),0.90(95%CI:0.79-0.96),and 0.85(95%CI:0.80-0.98),respectively.CONCLUSION The poor prognosis of patients receiving IMRT-based concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma may be closely related to LDH level,presence or absence of skull base invasion and N stage and the linear graph model based on the above prognostic factors has satisfactory efficacy in predicting the overall survival time of patients in follow-up.