CT引导射频消融联合化疗对鼻咽癌肝转移患者预后的影响

Radio frequency ablation combined with systemic chemotherapy in the management of nasopharyngeal carcinoma with liver metastasis

目的比较全身化疗联合CT引导射频消融（联合组）与单纯化疗对于鼻咽癌肝转移患者的疗效及预后的影响。方法本研究纳入在2000年1月至2013年12月间在中山大学肿瘤防治中心427例确诊为鼻咽癌伴肝转移并接受化疗的患者，其中男340例、女87例，中位年龄45岁（18～80岁），所有患者均接受全身化疗，部分患者在化疗的同时针对肝转移灶联合CT引导下的射频消融治疗。患者全身化疗期间每两程化疗后复查评估，完成治疗后每3个月随访1次直至其死亡或失访。研究采用倾向评分匹配法将联合组和化疗组进行1：1配对并做生存分析。结果在纳入的427例患者中，56例患者（13．1％）接受全身化疗联合射频消融治疗，371例患者（86．9％）只接受化疗。1：1倾向评分匹配后，从两组中共选出56对匹配的患者，化疗联合射频消融组患者的1、3、5年总生存期比率分别为89．2％、45．5％和32．5％，而单纯化疗组为77．1％、27．5％和4．8％。化疗联合射频消融组患者的1、3、5年无进展生存期比率分别为64．0％、25．4％和10．7％；多因素生存分析校正后示化疗联合射频消融组的总生存（风险比0．43，95％可信区间0．25—0．73）及无进展生存（风险比0．44，95％可信区间0．28～0．71）均优于单纯化疗组。结论全身化疗联合CT引导射频消融治疗较单纯化疗能够延长鼻咽癌肝转移患者的总生存期及无进展生存期。

Objective To determine the treatment efficacy of systemic chemotherapy combined with sequential CT-guided radiofrequency ablation （chemo-RFA） in the management of nasopharyngeal carcinoma （NPC） with liver metastasis. Methods A total of 427 NPC patients diagnosed with liver metastasis at Sun Yat-sen University Cancer Center between January 2000 and December 2013 were enrolled. Of the patients, 340 cases were male, 87 cases were female, the median age was 45 years （range 18 -80 years）, all patients received systemic chemotherapy and part of them also received RFA treatment. Patients were evaluated for response every two cycles during systemic chemotherapy and then every three months until death. One-to-one matched pairs between chemo-RFA group with chemo-only group were generated using propensity score matching; survival analysis was further conducted. Results Of all the enrolled patients, 56 patients （ 13.1% ） received combined treatment, 371 patients （ 86. 9% ） received chemotherapy alone. After propensity score matching, 56 pairs of well-matched liver metastatic NPC patients were selected from different treatment groups. The 1-, 3-, 5- year overall survival （OS） rates for chemo-RFA group were 89. 2%, 45.5% and 32. 5% and chemo-only group were 77. 1%, 27.5% and 4. 8% respectively; the 1-,3-, 5- year progression-free survival （PFS） rates for chemo-RFA group were 64. 0% ,25.4% and 10. 7% and chemo-only group were 44. 1% , 5.5% and 5.5% respectively. The adjusted hazard ratio in OS and PFS of the choice for chemo-RFA approach to chemo-only was HR 0. 43,95% CI 0. 25 - 0. 73 and HR 0. 44, 95% CI 0. 28 -0. 71 respectively. Conclusion CT-guided RFA combined with chemotherapy approach could improve the survival rate for NPC patients with liver metastasis.