406例鼻咽癌患者预后多因素分析

Multivariable Analysis of Prognostic Predictors for 406 Patients with Nasopharyngeal Carcinoma

目的:探讨鼻咽癌患者预后的影响因素,建立预后预测模型,为临床治疗提供参考。方法:对1996年12月至1997年12月接受治疗的鼻咽癌初治患者406例的分期、颈淋巴结转移情况等进行分析。应用COX回归模型分析预后影响因素,建立预后指数(prognosticindex,PI)方程,并根据PI值将全部患者分为不同的危险组,计算各组的生存曲线。结果:单因素分析显示年龄,T、N、M分期和临床分期,颅底骨质破坏,颈淋巴结转移情况,放射剂量等因素影响预后(P<0.05)。多因素分析显示N、M分期、临床分期和化疗与否是影响预后的主要因素。结论:PI值能较好的反映预后,为临床进行分层个体化治疗和预后预测提供参考。

Objective: To explore the prognostic factors of patients with nasopharyngeal carcinoma (NPC) after treatment and to establish a predictive model of prognostic index (PI) for physicians to give individualized treatment regimen. Methods: From December 1996 to December 1997, 406 patients with nasopharyngeal carcinoma who were treated in our department were analyzed retrospectively. Prognostic factors were analyzed and PI equation was built using Cox regression model. The prognostic index (PI) of patients was calculated on basis of the multivariate analysis. According to PI values, patients were classified into 4 different risk groups. The survival curves of each group were obtained. Results: Single factors analysis showed that age, T stage, N stage, M stage, clinical stage, invasion of skull base, cervical lymph nodes metastasis and radiotherapy doses were prognostic factors; Multivariate analysis revealed that N stage, M stage, clinical stage and having chemotherapy or not were independent factors for overall survival. Conclusions: The N stage, M stage, clinical stages as well as performance of chemotherapy or not are the important prognostic factors of NPC. PI value will be very useful in predicting patients' prognosis and may provide the valuable information for physicians to give stratified or individualized treatment regimen.