164例鼻咽癌放射治疗疗效和预后因素分析

Therapeutic effect and prognostic analysis of 164 cases of nasopharyngeal carcinoma after radiotherapy

目的分析164例鼻咽癌患者的放射治疗疗效和预后因素。方法常规放射治疗(CRT)128例,调强适形放射治疗(IMRT)36例。采用Kaplan-Meier法进行生存分析,单因素分析采用Logrank法检验,多因素分析采用Cox回归模型。RTOG/EORTC标准评价急性反应和晚期损伤。结果全组死亡50例,5年总生存率为67.6%。CRT组和IMRT组5年生存率分别为70.5%和51.3%(χ2=1.46,P>0.05)。多因素分析结果显示,N、M分期和首程治疗后完全缓解率是独立预后因素。全组患者多数表现1～2级急性放射反应和0～2级后期放射损伤,未观察到3级或4级急性反应和晚期损伤。CRT组和IMRT组患者发生2级口腔及咽部黏膜急性反应发生率分别70%、22%(P<0.05)。放疗后1年发生轻中度口干CRT组和IMRT组发生率分别是96%、33%(P<0.05)。结论 N、M分期和首程后完全缓解率可以作为判断鼻咽癌临床预后的参考指标。鼻咽癌患者经IMRT和CRT远期生存率差异无统计学意义,但放疗反应明显减轻,明显提高生存质量。

Objective To analyze the therapeutic effect of nasopharyngeal carcinoma after radiotherapy,and to explore its prognostic factors.Methods 128 patients received conventional radiotherapy（CR）alone and the remaining 36 were treated by intensity modulated radiation therapy（IMRT）.Kaplan-Meier method was used for survival analysis and Cox regression model for multivariate analysis.Acute and late toxicities were graded according to RTOG radiation morbidity scoring criteria.Results Fifty patients died during the follow-up,and the 5-year overall survival（OS）rate was 67.6%.For patients received CR alone and those were treated by IMRT,the 5-year OS rate was 70.5% and 51.3%,respectively（P〈0.05）.Multivariate analysis showed that N,M stage and CR rate of the primary treatment were the significant prognostics factors.Most of the patients had grade 1 to 2 acute and grade 0 to 2 late toxicities,no one had grade 3 or 4 acute or late toxicities.The incidence rate of the patients who suffered acute oral mucosa reaction of grade Ⅱ in CR and IMRT group was 70% and 22%（P〈0.05）.96% of the patients who received CR suffered light moderate xerostomia,while 33% of the patients were treated by IMRT for one year after radiotherapy.Conclusion N,M stage and CR rate of the primary treatment may be the independent prognostic factors.There is no significant difference between the patients with nasopharyngeal carcinoma treated by IMRT and CR on the long-term survival rate,but IMRT can reduce the radiotherapy reaction and improve the quality of life obviously.