早期鼻咽癌放疗失败模式分析

The failure patterns of early stage nasopharyngeal carcinoma treated by radiotherapy alone

目的分析早期鼻咽癌患者放疗失败模式及其与临床因素的相关性,探讨提高早期鼻咽癌治疗效果的方法。方法回顾性分析行单纯根治性放射治疗的早期(T1-2N0-1M0)鼻咽癌患者350例,计算其5年生存率、无局部区域复发生存率、无远处转移生存率、局部区域控制率及远处转移率;计算局部区域复发和转移的发生率,总结其放疗失败模式;分析与放疗失败相关的临床因素;将患者按T、N期分层,计算其5年无局部区域复发生存率及无远处转移生存率。结果本组患者的5年总生存率、无局部区域复发生存率及无远处转移生存率分别为82.8%、89.1%、86.7%,5年局部区域控制率及远处转移率分别为82.6%、13.1%。T1N0、T2N0、T1N1及T2N1期患者的5年生存率分别为95.3%、88.0%、81.3%及72.9%(P<0.05)。所有患者中96例(27.4%)治疗失败:其中局部区域复发61例,远处转移46例,局部区域复发+远处转移11例。鼻腔受累、N分期及临床分期对局部区域复发率有显著影响(P<0.05),N分期和临床分期对远处转移率有显著影响(P<0.05)。不同T、N分期患者的无局部区域复发生存率及无远处转移生存率具有显著性差异。结论局部区域复发和远处转移是早期鼻咽癌治疗失败的主要模式;T1-2N1患者预后差,应采取综合治疗措施以提高疗效。

Objective To analyze the failure patterns of early stage nasopharyngeal carcinoma treated by radiotherapy,and the relationship between the failure patterns and clinical factors,and to explore the way to improve the therapeutic efficacy of radiotherapy.Methods The data of 350 patients diagnosed as early stage（T1-2N0-1M0） nasopharyngeal carcinoma and received radical radiotherapy alone were retrospectively analyzed.The 5-year overall survival rate（OS）,local regional recurrence-free survival rate（RFS）,distant metastasis-free survival rate（DMFS）,local regional control rate（LCR） and distant metastasis rate（DMR） were determined.Failure patterns were determined according to the results of local regional recurrence rate（LR） and metastasis rate（MR）,meanwhile the clinical features related to failure patterns of radiotherapy were analyzed.The patients were stratified to the T and N stage,and the 5-year RFS and DFS were subsequently calculated.Results The 5-year OS,RFS,DMFS was 82.8%,89.1% and 86.7%,respectively.The 5-year LCR and DMR was 82.6% and 13.1%,respectively.The 5-year OS of T1N0,T2N0,T1N1,T2N1 was 95.3%,88.0%,81.3% and 72.9%,respectively（P〈0.05）.Among a total of 350 patients received radical radiotherapy,96 cases（27.4%） suffered treatment failure,including 61 cases with local regional recurrence,46 with distant metastasis,11 with both local regional recurrence and distant metastasis.Nasal cavity involvement,N staging（92＇ Fuzhou） and clinical staging threw significant influence on the l local regional recurrence,while N staging and clinical staging threw significant influence on the distant metastasis.RFS and DMFS were significantly different in patients with different T and N stages.Conclusions Local regional recurrence and distant metastasis are the main failure patterns in early stage nasopharyngeal carcinoma having received radiotherapy alone.Patients in T1-2N1 group may have a poor prognosis,and combined treatment is ncessary instead of radiotherapy alone.