鼻咽癌放疗前血红蛋白浓度对局部控制的影响

Impact of Pre-radiotherapy Hemoglobin Level on Local Control of Nasopharyngeal Carcinoma

背景与目的:氧对放射治疗有增敏作用,而研究表明患者血红蛋白浓度<130g/L容易出现肿瘤乏氧。本研究探讨鼻咽癌放射治疗前血红蛋白浓度<130g/L对放射治疗结果的影响。方法:收集中山大学肿瘤防治中心1999～2000年间经病理确诊的166例鼻咽癌患者的临床及随访资料,根据放射治疗前患者血红蛋白浓度分为高血红蛋白组(≥130g/L)和低血红蛋白组(<130g/L)。全部病例均接受根治性放疗。Cox模型多因素分析血红蛋白浓度、T分期等对鼻咽癌局部控制预后的影响。结果:本组鼻咽癌患者放射治疗前血红蛋白浓度的中位水平为135g/L,其中68例(41%)血红蛋白浓度<130g/L,98例(59%)血红蛋白浓度≥130g/L。低血红蛋白组和高血红蛋白组患者的3年无局部复发生存率分别为78%和90%(P=0.015),3年无远处转移生存率分别为75%和77%(P=0.763),3年总生存率分别为73%和83%(P=0.056)。Cox模型多因素分析显示放射治疗前血红蛋白浓度、T分期和性别是影响局部复发的独立预后因素。结论:患者放疗前血红蛋白浓度<130g/L是影响鼻咽癌局部控制的预后因素之一。放疗前和放疗中维持血红蛋白浓度≥130g/L对鼻咽癌的治疗作用值得前瞻性研究。

BACKGROUND & OBJECTIVE: Oxygen increases tumor sensitivity to radiotherapy; tumor hypoxia is more prevalent in tumor patients with pretreatment hemoglobin concentration of < 130 g/L. This study was to evaluate impact of pre-radiotherapy hemoglobin level on radiotherapy outcome of nasopharyngeal carcinoma (NPC) patients. METHODS: Clinical and follow-up data of 166 NPC patients received definitive radiotherapy from 1999 to 2000 were reviewed. Pre-radiotherapy hemoglobin levels were stratified as high (≥130 g/L) and low (< 130 g/L). Cox regression analysis was used to determine factors affecting local control. RESULTS: The median pre-radiotherapy hemoglobin level of the 166 patients was 135 (85-189) g/L. Hemoglobin was < 130 g/L in 68 (41%) patients, and ≥130 g/L in 98 (59%) patients. The pre-radiotherapy hemoglobin level of < 130 g/L was related to low 3-year local relapse-free survival rate (78% vs. 90%, P=0.015), but had no relations with distant metastasis-free survival (75% vs.77%, P=0.763) and overall survival rates (73% vs. 83%, P=0.056). Multivariate analysis showed that pre-radiotherapy hemoglobin level, T stage, and gender were independent prognostic factors for local failure. CONCLUSIONS: Pre-radiotherapy hemoglobin of < 130 g/L is a prognostic factor for local control of NPC. Strategies for maintaining pre-radiotherapy hemoglobin of ≥130 g/L before radiotherapy and during treatment should be further explored.