唑来膦酸联合化疗治疗在鼻咽癌骨转移患者的临床疗效及其预后因素研究

The research and significance of Zoledronic acid combined with chemotherapy treatments in nasopharyngeal carcinoma with bone metastases patients

目的观察唑来膦酸(ZA)联合化疗治疗鼻咽癌(NPC)骨转患者的临床疗效及其预后因素。方法回顾性分析306例鼻咽癌伴骨转移患者的临床资料,将患者分为唑来膦酸联合化疗治疗组(143例)及单独化疗组(163例)两组,采用Kaplan-Meier方法及log-rank检验验证两组总生存期(OS)及无疾病进展时间(PFS)是否存在差异。单因素及多因素分析均使用Cox回归分析。比较治疗方法、临床因素及骨相关事件(SREs)的发生率。结果唑来膦酸联合化疗治疗组与单独化疗组OS中位值分别为(24.0±1.3)个月(95%CI:21.4～26.6)及(17.0±1.7)个月(95%CI:13.6～20.4),差异有统计学意义(P<0.001)。唑来膦酸联合化疗治疗组与单独化疗组PFS分别为(11.0±1.04)个月(95%CI:8.9～13.0)和(6.0±0.65)个月(95%CI:4.7～7.7),差异有统计学意义(P<0.001)。唑来膦酸联合化疗治疗组骨相关事件(SREs)的发生率为25.2%,明显低于单独化疗组的42.0%,差异有统计学意义(χ2=9.728,P=0.002)。接受ZA治疗为OS独立的有利预后因素,而SREs、椎骨转移的发生以及高血清碱性磷酸酶(ALP)水平是OS的独立的不良因素。结论化疗联合ZA治疗能够使鼻咽癌骨转移患者生存获益。与单独化疗相比,联合治疗可以降低SREs的发生率,延长治疗PFS以及OS。

Objective To evaluating whether Zoledronic acid （ZA ）can bring survival benefits to nasopha-ryngeal carcinoma （NPC） with bone metastases .Methods 306 patients was analyzed diagnosed NPC with bone metastases retrospectively .Divided these patients into two groups by receiving ZA or not and evalua-ted whether there exit the differences of OS and PFS between two groups by the log-rank test .The Cox multivariate analyses of clinical features and different treatment methods of the patients were conducted . Results The prevalence of SREs in the combined approach group was lower than that with chemotherapy alone （25 .2% vs 42 .0% ,χ2 =9 .728 ,P =0 .002） .The combined approach group had better progression-free survival （PFS） （11 .0 vs .6 .0 months ,P〈0 .001） and overall survival （OS） than chemotherapy alone group （24 .0 vs .17 .0 months ,P 〈0 .001） .Cox multivariate analysis identified the following independent prognostic factors ：ZA treatment ,bone metastatic sites ,baseline serum alkaline phosphatase （ALP） level and SREs .Conclusions ZA combined with chemotherapy could improve PFS and OS reduce and SREs for NPC with bone metastases .