鼻咽癌根治性放射治疗的预后分析

Prognostic analysis of patients with nasopharyngeal carcinoma treated by radical radiotherapy

目的:观察鼻咽癌患者根治性放疗的疗效,探讨影响鼻咽癌放疗疗效及预后的因素。方法:对影响患者预后的因素,包括年龄、性别、KPS评分、T和N分期、临床分期、同期化疗及影像诊断技术等进行单因素和多因素分析。采用Kaplan-Meier法计算生存率,Log-Ranktest对生存率进行检验,Cox风险比模型进行多因素分析。结果:中位随访期为40.6个月(2.5～84个月),全组有46例出现局部区域复发。全组5年总生存率、无进展生存率、无复发生存率及无远处转移率分别为72.7%,65.3%,83.1%和79.4%。单因素分析显示,年龄、性别、KPS评分、T和N分期及影像诊断技术等是影响预后的因素。多因素分析显示,年龄、性别、T和N分期是影响总生存率的独立预后因素;年龄、性别、临床分期及淋巴结侧数是影响无进展生存率的独立预后因素;KPS评分、颅内受侵及颅底骨质破坏是影响局部复发的独立预后因素;T分期、N分期及淋巴结侧数是影响远处转移的独立预后因素。结论:年龄、性别、KPS评分、T和N分期及临床分期是影响鼻咽癌患者生存最重要的独立预后因素。

OBJECTIVE： To evaluate the efficacy and outcome of patients with nasopharyngeal carcinoma （NPC） treated by radical radio-therapy and explore the prognostic factors of NPC patients after radio-therapy. METHODS： Factors related to prognostic significance, inclu ding age, gender, Karnovsky performance status（KPS）, detail characters of T/N classification, T/N classification, clinical stage, concur rent chemotherapy and imaging diagnostic techniques were investigated in the univariate and multivariate analysis. Kaplan-Meier method was used for survival analysis and the Log-Rank test was used to detect the differences between the different groups. Cox regression model was used for multivariate analysis of related prognostic factors. RESULTS： With a median follow-up of 40. 6 months （range 2. 5- 84 months）, there have been 46 local-regional recurrence. The 5-year overall survival （OS）, progression-free survival （PFS）, recurrence-free survival （RFS） and distant metastasis free survival （DMFS） rates were 72.7%, 65.3%, 83.1% and 79.4%, respectively. Univariate analysis showed age, gender, KPS, almost all factors of T/N classification, and imaging techniques were statistically significance. Multivariate anal ysis showed that independently significantly prognostic factors for OS were gender, age and T/N classification. Independently significantly prognostic factors for PFS were gender, age, clinical stage and the lymph node laterali- ty. Independently significantly prognostic factors for RFS were skull base erosion, intracranial involvement and KPS. Independently significantly prognostic factors for DMFS were T/N classification and the lymph node laterality. CONCLUSIONS： Age, gender, KPS, T/N classification and clinical stage are the most important independently significantly prognostic factors for survival of patients with NPC.