鼻咽癌2008分期与＇92分期的比较研究

Comparative study of nasopharyngeal carcinoma staging system between the chinese 2008 and＇92 Fuzhou

目的 通过分析MRI诊断的鼻咽癌资料,对鼻咽癌2008分期和＇92分期进行比较研究.方法 回顾分析777例行鼻咽和颈部MRI扫描的无远处转移鼻咽癌初诊患者的临床及影像资料,分别根据鼻咽癌2008分期与＇92分期标准重新分期,比较两种分期系统的病例分布、生存及预后情况.777例患者中513例常规放疗,264例调强放疗.结果 3年随访率为97.6%.两种分期中T分期、N分期和临床分期的病例分布相似（Kappa=0.93,P=0.000;Kappa=0.58,P=0.000;Kappa=0.74,P=0.000）,T分期局部复发生存曲线和临床分期疾病相关生存曲线也比较一致.＇92分期标准下N0与N1期无远处转移生存曲线相似（x2=1.94,P=0.164）,N1与N2期的曲线接近有统计学意义（x2=3.83,P=0.051）;2008分期标准下N0与N1a期曲线相交叉（x2=0.07,P=0.797）,但N1b与N2、N2与N3期曲线均能较好拉开（x2=4.95,P=0.026;x2=6.74,P=0.009）.预后分析结果显示常规放疗与调强放疗不是影响生存的因素（x2=3.60,P=0.058）,2008分期将淋巴结侧数、分区、包膜外侵犯纳入N分期标准中是合理的（x2=6.59,P=0.010;x2=4.78,P=0.029;x2=9.32,P=0.002）.结论 鼻咽癌2008分期的T分期简化是合理的,N分期可以更好的预测远处转移,咽后淋巴结在分期中的地位值得进一步探讨.

Objective To carry out a comparative study between the Chinese 2008 and＇92 staging system of nasopharyngeal carcinoma （NPC）. Methods A total of 777 patients presented with untreated nondisseminated NPC who had received MRI scan of nasopharynx and neck were studied retrospectively. The clinical materials and information of imaging were collected. All patients were restaged according to the Chinese 2008 and 92 staging system of nasopharyngeal carcinoma. Distribution of T, N stage, survival and prognostic value were compared. 513 patients of the 777 cases were treated with conventional radiotherapy,264 cases with intensity modulated radiation therapy. Results The 3-year follow-up rate was 97.6%. The consistency of T stages was 95.0%. T, N and clinical stage distributions in two systems were similar （ Kappa = 0. 93, P = 0. 000; Kappa = 0. 58, P = 0. 000; Kappa = 0. 74, P = 0. 000）. Local failure-free survival and disease specific survival were also similar. There was no difference of distant metastasis between N0 and N1（x2 = 1.94,P=0. 164）, and a marginal difference between N1 and N2（x2 =3.83,P=0.051） in the Chinese＇92 staging system. However, although there was also no difference of distant metastasis-free survival between No and N1a（x2 =0. 07,P =0. 797）, ） the difference of overall survival among N1b, N2, and N3 were significant （ x2 = 4. 95, P = 0. 026; x2 = 6. 74, P = 0. 009） in the Chinese 2008 staging system. Conventional radiotherapy or intensity modulated radiation therapy was not a prognostic factor for survival （ x2 = 3.60,P =0. 058）. It is reasonable for the Chinese 2008 staging system integrated lymph node characteristics such as laterality, level and extranodal neoplastic spread into the N staging criteria （ x2 = 6. 59, P = 0. 010; x2 =4.78,P=0. 029;x2=9.32,P=0. 002）. Conclusions For the Chinese 2008 staging system, it was reasonable to simplify the previous T stage. The N stage showed a better predictive role of distant failure.The role of retropharyngeal lymph node in stage system needs further investigation.