鼻咽癌治疗后远处转移影响因素的Cox分析

Cox analysis of some factors affecting distant metastasis of nasopharyngeal carcinoma after treatment

目的:探讨鼻咽癌患者治疗后发生远处转移的影响因素,建立远处转移的预测模型。方法:收集鼻咽癌治疗后发生远处转移的158例住院患者临床资料,采用Cox回归模型分析远处转移的影响因素。建立远处转移危险指数方程(IE),根据IE值将全部患者分为不同的危险组,采用Log-rank检验进行分析。结果:单因素分析显示,T分期、N分期、临床分期、颈淋巴结转移和颈部放疗剂量影响治疗后远处转移(χ2值分别为29.63、54.83、58.42、24.86和5.91,P均<0.05),临床分期分层分析结果显示,Ⅲ、Ⅳ期鼻咽癌患者化疗与否无远处转移生存曲线分离,χ2值分别为4.42、3.93,P均<0.05。多因素分析表明,N分期、临床分期和化疗是影响鼻咽癌治疗后远处转移的独立因素(β值分别为0.435、0.761、0.697,P均<0.01),不同危险组无远处转移生存率差异有统计学意义,P<0.01。结论:IE值能较客观地预测远处转移的危险性,为临床进行个体化治疗提供参考。

OBJECTIVE： To study the influential factors of distant metastasis （DM） after treatment in patients with nasopharyngeal carcinoma （NPC）, and to establish a predictive model of DM. METHODS： Totally 158 NPC patients with DM after treatment were collected, and their data were analyzed retrospectively. Influential factors were analyzed and hazard index equation （IE） for DM was built using Cox regression model IE value was calculated on basis of multivari able analysis. According to IE values, patients were categorized into 4 different risk groups and inter-group comparison was made with Logrank methods. RESULTS： Univariate factor analysis showed that T stage, N stage, clinical stage, cervical lymph nodes metastasis, cervical radiation dose were influential factors of DM after treatment （7.2 values were 29.63, 54.83, 58.42, 24.86 and 5.91, respetively, all P〈0.05）. Layering analysis for clinical stage revealed that survival curve without DM for pa tients of chemotherapy or non-chemotherapy of Ⅲ, Ⅳ stage with NPS were different （χ^2 values were 4.42 and 3.93, P〈0.05）. Muhivariable factors analysis revealed that N stage, clinical stage and chemotherapy were main influential factors of distant metastasis in patients of NPC after treatment （β values were 0. 435, 0. 761 and 0. 697,P〈0.01）. Difference of survival rate without DM in different risk groups was very significant, P〈0.01. CONCLUSION： IE value will be very useful in predicting risk of distant metastasis in these patients, and show evidence for physicians to formulate individualized treatment regimen.