初治转移鼻咽癌疗后预后评分模型建立及分层治疗研究

Post-treatment prognostic score model establishment and stratified therapy for newly diagnosed metastatic nasopharyngeal carcinoma

目的：建立初治转移鼻咽癌疗后预后评分模型，探讨其分层治疗的可行性。方法2002—2010年共263例符合入组条件的初治鼻咽癌转移患者纳入研究。原发灶主要包括常规放疗、3DCRT、IMRT 等，照射范围包括鼻咽病灶＋颈部淋巴引流区。骨转移病灶的处理主要是常规外放疗，肝、肺等主要选择手术切除、放疗及射频消融处理等。大部分患者一线治疗均采用以顺铂为基础的联合化疗方案。将患者一般特点、肿瘤状态以及治疗相关因素等纳入多因素分析，根据预后因素n 值（其中 HR＝en ）建立预后模型。结果影响患者 OS 因素包括 KPS≤70（P＝0.00）、联合器官转移（P＝0.00）、合并肝转移（P＝0.00）、转移数目≥2个（P＝0.00）、LDH＞245 IU／ I （P＝0.00）、化疗周期数1～3个（P＝0.00）、转移灶疗效为 SD 或 PD （P＝0.00）、原发灶未接受放疗（P＝0.01）。根据患者预后评分分为低危组（0～1.5分）、中危组（2．0～6.5分）、高危组（≥7.0分），5年 OS 率分别为59.0％、25.1％、0（P＝0.00）。结论基于患者 KPS、血清 LDH 水平及联合脏器转移、合并肝转移、转移数目建立的预后评分模型能有效预测患者生存，积极的治疗方式包括≥4个周期化疗和原发灶放疗等能提高低、中危组患者生存时间；而对高危组患者原发灶放疗不能带来生存获益，以姑息性化疗为主。

Objective To establish a post.treatment prognostic score model for newly diagnosed metastatic nasopharyngeal carcinoma, and to investigate the feasibility of stratified therapy. Methods A total of 263 eligible patients with newly diagnosed metastatic nasopharyngeal carcinoma from 2002 to 2010 were enrolled as subjects. The primary tumor was treated with conventional radiotherapy, three.dimensional conformal radiotherapy, or intensity.modulated radiotherapy, and radiation areas included nasopharyngeal tumor and cervical lymphatic drainage region. The metastatic bone tumor was mainly treated with conventional external radiotherapy, while the metastatic liver or lung tumor was mainly treated with surgical resection, radiotherapy, or radiofrequency ablation. The first.line therapy for most of patients was cisplatin.based combination chemotherapy. Factors including the general characteristics, tumor status, and therapy for patients were involved in multivariate analysis, and a prognostic model was established based on the n value （HR=en ） of the prognostic factors. Results The factors influencing the overall survival （OS） in patients were a Karnofsky performance score （KPS） not higher than 70（P= 0. 00）, multiple organ metastases （P=0. 00）, combination with liver metastasis （P= 0. 00）, a number of metastases not less than 2（P= 0. 00）, a level of lactate dehydrogenase （LDH） higher than 245 IU/ L （P= 0. 00）, a number of chemotherapy cycles ranging between 1 and 3（ P= 0. 00）, a poor response for metastatic tumor （ stable disease or progressive disease）（P= 0. 00）, and primary tumor not treated with radiotherapy （P= 0. 01）. Based on the prognostic＆amp;nbsp;score, patients were divided into low.risk group （0.1. 5 points）, intermediate.risk group （2. 0.6. 5 points）, and high.risk group （≥7. 0 points）, and the 5.year OS rates in the three groups were 59. 0%, 25. 1%, and 0%, respectively. Conclusions The prognostic score model based on the KPS, serum level of LDH, multiple organ metastases, combination with liver metastasis, and number of metastases can effectively predict the survival in patients. Active treatment including at least 4 chemotherapy cycles and radiotherapy for primary tumor can prolong the survival time of patients in the low.and intermediate.risk groups. However, patients in the high.risk group were mainly treated with palliative radiotherapy due to no improvement in the survival by radiotherapy for primary tumor.