同期化疗对Ⅲ期鼻咽癌放疗患者预后影响的回顾性分析

Effect of concomitant chemotherapy on prognosis of patients with stage Ⅲ nasopharyngeal carcinoma after radiotherapy:A retrospective analysis

目的:分析并评价同期化疗对提高Ⅲ期鼻咽癌患者放疗后远期生存率的影响和价值。方法:收集首程治疗Ⅲ期鼻咽癌患者507例,其中178例放疗同期联合含顺铂方案的化疗。Kap-lan-meier法计算生存率,Log-rank检验并行预后的单因素分析,Cox比例风险模型进行多因素预后分析。结果:中位随访时间53个月。Ⅲ期鼻咽癌患者的5年总生存率、局部区域无复发生存率、无远处转移生存率和无瘤生存率分别为65.8%、81.4%、75.0%和62.5%。放化组总生存率为71.6%,单放组为62.7%,χ2=4.830,P=0.028;局部区域无复发生存率放化组为90.5%,单放组为76.3%,χ2=11.464,P=0.001;无远处转移生存率放化组为77.4%,单放组为73.6%,χ2=1.092,P=0.296;无瘤生存率放化组为70.6%,单放组为58.1%,χ2=8.078,P=0.004。单因素分析结果表明,同期化疗是影响鼻咽癌治疗总生存率、局部区域无复发生存率和无瘤生存率的预后有利因素。多因素分析结果显示,同期化疗是影响局部区域无复发生存率和无瘤生存率的独立预后因素。结论:同期化疗有助于提高Ⅲ期鼻咽癌放疗后的局部区域无复发生存率和无瘤生存率。

OBJECTIVE： To evaluate the impacts of chemotherapy combined with radiotherapy on the survival of patients suffered from stage Ⅲ nasopharyngeal carcinoma （NPC）. METHODS： Five-hundred and seven cases of Stage Ⅲ NPC treated with combined radio-chemotherapy or radiation alone, were retrospectively analyzed. The patients included 178 cases received cisplatin-based chemotherapy concurrently with radiation. Kaplan-Meier method was used to analyze the survival and log-rank test was used to evaluate the difference between the groups. Cox regression model was used to analyze the prognostic factors. RESULTS： Median follow-up time was 53 months. The 5-year overall survival （OS）, local regional recurrent-free survival （LRRFS）, distant metastases-free survival （DMFS）, and disease-free survival （DFS） of whole cohort were 65.8%, 81.4%, 75.0% and 62.5%, respectively. The OS in patients with concurrent chemoradiotherapy and with radiotherapy alone were 71.6% and 62.7%, respectively （x^2 = 4. 830, P=0. 028）. The LRRFS was also in favour of concomitant chemoradiotherapygroup （90.5% vs 76.3%, x^2=11.464, P=0.001）. The DFS was 77.4% in chemoradiotherapy group while it was 73.6% in radiation alone group （x^2 = 1. 092, P= 0. 296）. The DFS improved significantly in chemoradiotherapy compared with radiotherapy alone （70.6% vs 58.1%, x^2 = 8. 078, P= 0. 004）. Univariate analysis revealed that concomitant chemotherapy was one of the significant prognostic factors for OS, LRRFS and DFS. In the Cox regression analysis, it was proved that concomitant chemotherapy remains to he independent predictive factor for better LRRFS and DFS. CONCLUSION： For stage Ⅲ NPC patients who received conventional radiotherapy, the concomitant addition of cisplatin and 5-FU have a statistically significant positive impact on the LRRFS and DFS.