178例鼻咽癌患者不同临床分期方法与预后的比较

A comparison of patients distribution and efficacy in predicting prognosis according to different staging systems for one hundred seventy eighty nasopharyngeal carcinoma patients

背景与目的：在世界范围内采用几种不同的鼻咽癌分期方法，这种现象不利于对不同地区鼻咽癌治疗疗效和预后因素的分析。本研究比较不同分期方法与预后的价值，以期找到一个较理想的分期方法。方法：178例无远处转移的初治鼻咽癌患者行超分割后程加速放疗，原发灶全疗程总剂量为78 Gy，60分次，6周完成。采用92福州会议，香港Ho＇s和1997 AJCC／UICC 5th标准进行分期，并且根据T、N组合成4个不同预后组。中位随访期为66．7个月。结果：无论采用哪一种分期标准，绝大多数的患者属于Ⅱ/Ⅲ期。根据92福州分期Ⅰ～Ⅳ期患者的总体生存率分别为85．9％、89．9％、54．3％和42．6％，Ⅰ：Ⅱ和Ⅲ：Ⅳ之间差异未达到统计学意义。另2种分期标准也存在此现象。对4个不同预后组分析，显示根据92福州分期和1997 AJCC／UICC 5th标准早期组疗效最好，原发晚期组和颈部晚期组的失败分别以鼻咽部复发和远地转移为主，局部区域晚期组疗效最差。结论：在不同期别患者的病例数分布和区分生存率等曲线上，3种分期标准无明显区别。采用92福州分期和1997 AJCC／UICC 5th分期标准，可以将患者分成显著不同预后和失败模式的组别。

Background and purpose： Since different staging classifications for nasopharyngeal carcinoma have been used throughout the world, it is difficult to compare the treatment outcome and find prognostic factors for patient who are defined TNM stage based on different systems. Our aim was to compare three staging systems in terms of patients distribution and efficacy in predicting prognosis, and hope to find an ideal staging classification. Methods： One hundred and seventy eight patients diagnosed as nasopharyngeal carcinoma without distant metastasis were treated with late-course accelerated hyperfractionated radiotherapy （78 Gy/60 Fx/6w）. Patients were originally defined by TNM stage according to the Chinese 1992 Fuzhou staging system, re-staged according to the Ho＇s staging system and the fifth edition AJCC/UICC staging manual respectively. In addition to stage grouping, patients were also classified into different prognostic categories to study the failure patterns. The median follow up was 66.7 months. Results： Most of the patients were classified as stage Ⅱ or Ⅲ diseases no matter which staging system was used. The 5-year overall survival rate in the Chinese 1992 stage Ⅰ-Ⅳ were 85.9%, 89.9%, 54.3% and 42.6%, difference between stage Ⅰ and Ⅱ or Ⅲ and Ⅳ did not reach statistical significance. The same phenomenon was also observed in the other two systems. The analyses of the four prognostic categories revealed that the early disease group had the best treatment outcome, and failure patterns of the advanced local disease group and the advanced nodal disease group were primary recurrence and distant metastasis respectively, whereas the advanced locoregional disease group had the worst prognosis according to the Chinese 1992 staging or the fifth edition AJCC/UICC staging manual. Conclusions： Patients distribution and the segregation of survival curves among different stage groups were not very distinct among the three staging systems. Prognostic categories defined by the Chinese 1992 staging system or the fifth edition AJCC/UICC staging manual had obvious different prognosis and failure patterns.