鼻咽癌综合治疗策略研究——749例疗效分析

A Study of the Combined Treatment Strategy for Patients with Nasopharyngeal Carcinoma Based on the Analysis of the Treatment Results from 749 Cases

[目的]探讨鼻咽癌综合治疗策略。[方法]回顾性分析无远处转移初治鼻咽癌749例,按’92分期标准对所有病例重新分期。根据患者不同T、N组合的死亡风险比及生存情况,将病人分为5组:早期N0组(T1～2N0)、早期N1组(T1～2N1)、局部晚期组(T3～4N0～1)、区域晚期组(T1～2N2～3)、局部区域晚期组(T3～4N2～3)。比较各组的5年总生存率、5年累积局部区域复发率、远处转移率和死亡风险比等。[结果]早期N1组较早期N0组,5年总生存率明显下降(84.7%vs95.4%,P=0.005),5年远处转移率明显升高(10.8%vs0.1%,P=0.0004),死亡风险比分别为1和3.8;局部晚期组与区域晚期组比较,5年总生存率、累积远处转移率及累积局部区域复发率差异均无统计学意义穴61.4%vs63.9%、20.3%vs24.6%、19.1%vs15.6%,P>0.05雪,死亡风险比在同一层次,分别为10.1及10.0;局部区域晚期组5年总生存率仅48.2%,死亡风险比高达16.4。[结论]鼻咽癌的治疗应根据患者具体的T、N分期组合进行分层分析治疗,T1～2N0预后好,可予单纯放疗;T1～2N1病人应考虑放疗联合化疗的综合治疗,T3～4和/或N2～3患者有较高的复发及转移率,应增加放化疗综合治疗的强度。

[Purpose ]To explore the multimodality therapy for nasopharyngeal carcinoma （NPC）. [Methods]Seven hundred and forty-nine cases with non-metastatic NPC were retrospectively analyzed.All cases were restaged based on the Chinese staging system 1992. According to the death hazard ratios and survival rate of different combinations of T and N,patients were divided into five subgroups：early disease group with No （T1-2N0）, early disease group with N1 （T1-2N1）, advanced local disease group （T3-4N0-1）, advanced nodal disease group （T1-2N2-3） and advanced locoregional disease group （T3-3N2-3）. 5-year overall survival rate, 5-year cumulative locoregional failure rate, distant failure rate, and death hazard ratios were compared among subgroups. [Results I The early disease group with N1（T1-2N1） had a lower 5-year survival rate and a higher distant failure rate compared with the early disease group with No （T1-2N0） （84.7% vs. 95.4%,P=0.005, 0.1% vs. 10.8%, P=0.0004）. The hazard ratios were 1 and 3.8,respectively. No significant difference was found with the 5-year overall survival rates, 5-year cumulative distant failure rates, and locoregional failure rates between advanced local disease group （T3-4N1-2） and advanced nodal disease group （T1-2N2-3）（61.4% vs 63.9%, 20.3% vs 24.6%, 19.1% vs 15.6%,respectively,P〉0.05）. Their hazard ratios were in the same level with 10.1 and 10.0, respectively.For advanced locoregional disease group （T3-4N2-3）, the 5-year overall survival rate was only 48.2% and the hazard ratio was as high as 16.4. [Conclusions]Stratification according to the accurate combinations of T and N,should be involved in the consideration of treatment strategy for NPC.The treatment results in patients with T1-2N0 were excellent, radiotherapy alone was enough.For patients with T1-2N1,chemoradiotherapy may be indicated.Poorer survival rate and higher relapse rate were observed among patients with T3-4 or/and N2-3, more aggressive therapy was recommended.