诱导化疗联合同期放化疗对局部晚期鼻咽癌的远期疗效

Long-term Efficacy of Induction Chemotherapy Plus Concurrent Radiochemotherapy on Advanced Nasopharyngeal Carcinoma

背景与目的:诱导加同期放化疗有提高鼻咽癌患者无瘤生存率和总生存率的趋势,本研究对比鼻咽癌接受单纯放疗或诱导加同期放化疗的生存率差异,探讨增加诱导及同期化疗对鼻咽癌生存率的影响。方法:将1997年1月至1998年12月在中山大学肿瘤防治中心接受诱导加同期顺铂联合氟尿嘧啶方案化疗3～5疗程联合放疗75例鼻咽癌与同时期接受单纯根治性放疗的局部晚期住院患者460例的生存期进行比较。生存相关分析用Cox回归分析,组间生存率比较采用Kaplan-Meier法。结果:两组间生存率和无瘤生存率差异有统计学意义,放疗加化疗组优于单纯放疗组(P<0.05)。Ⅲ期患者组单纯放射治疗者中位生存期和中位无瘤生存期分别为85.1个月和82.9个月,而化疗加放疗组为94.5个月和89.5个月,两组差异有统计学意义(P<0.05)。Ⅳa期患者组单纯放射治疗者中位生存期和中位无瘤生存期分别为44.4个月和40.3个月,化疗加放疗组为82.4个月和69.6个月,两组差异同样有统计学意义(P<0.05)。Cox回归分析显示,临床分期和化疗与否是独立预后因素。结论:诱导化疗加同期放化疗治疗鼻咽癌可提高Ⅲ、Ⅳa期患者的生存率。

BACKGROUND ＆ OBJECTIVE： Induction chemotherapy plus concurrent radiochemotherapy may prolong disease-free and overall survival of advanced nasopharyngeal carcinoma （NPC） patients. This study was to compare the long-term efficacy of induction chemotherapy plus concurrent radiochemotherapy and radiotherapy alone on advanced NPC. METHODS： Clinical data of 535 advanced NPC patients, treated in Cancer Center of Sun Yat-sen University from Jan. 1997 to Dec. 1998, were analyzed. Of the 535 patients, 75 were treated with 3-5 cycles of induction and concomitant chemotherapy of PF regimen （cisplatin combined 5-fluorouracil） plus radiotherapy, 460 were treated with radiotherapy alone. The survival statuses of the 2 groups were compared. Prognostic factors were analyzed by Cox regression analysis. Cumulative survival rate was analyzed by Kaplan-Meier method. RESULTS： The 5-year overall and disease-free survival rates were significantly higher in radiochemotherapy group than in radiotherapy group （78.15% vs. 55.27%, 71.55% vs. 48.99%, P〈0.05）. For the patients with stage Ⅲ tumors, the median overall and disease-free survival term were significantly longer in radiochemotherapy group than in radiotherapy group （94.5 months vs. 85.1 months, 89.5 months vs. 82.9 months, P〈0.05）. For the patients with stage Ⅳ a tumors, the same results were obtained （82.4 months vs. 44.4 months, 69.6 months vs. 40.3 months, P〈0.05）. Cox regression analysis showed that clinical stage and chemotherapy were dependent prognostic factors of advanced NPC. CONCLUSION： Induction chemotherapy plus concurrent radiochemotherapy could prolong the survival of patients with advanced NPC.