4F-CRT治疗255例鼻咽癌的预后因素分析

Efficacy and safety of 4F-CRT in treatment of nasopharyngeal carcinoma: A study of 255 cases

目的分析大样本量鼻咽癌（nasopharyngeal carcinoma,NPC）患者接受四野面颈联合野放疗（four faciocervical fields conformal radiotherapy,4F-CRT）的疗效及不良反应,并探讨其预后因素。方法分析接受4F-CRT的255例初治鼻咽癌患者临床资料。所有患者治疗前行鼻咽MRI,采用直线加速器6 MV X线进行治疗,常规分割,2 Gy/f,每周5天连续放疗。其中231例Ⅱ-ⅣB期患者接受以铂类为基础的化疗。生存分析采用Kaplan-Meier方法,Log-rank法检验差异性。Cox风险比例模型进行多因素分析。结果中位随访43月（8-79月）,所有患者3年与5年局控率、无瘤生存率、总生存率分别是83.3%、82.0%、83.8%和76.1%、73.2%、76.3%。单因素分析显示,临床分期（P〈0.01）、T分期（P〈0.01）、N分期（P=0.001）和即时疗效（P=0.025）与预后有关。多因素分析显示,年龄（P=0.004）、T分期（P〈0.01）、N分期（P〈0.01）和联合化疗（P=0.04）是影响鼻咽癌的独立预后因素。不良反应主要为Ⅰ-Ⅱ级放射性黏膜炎和白细胞下降。结论 4F-CRT治疗鼻咽癌疗效好,无严重不良反应,联合化疗、T分期、N分期和年龄是影响预后的独立因素。

Objective To evaluate the efficacy and safety of four facio-cervical fields conformal radiotherapy（ 4FCRT） in treatment of nasopharyngeal carcinoma（ NPC）. Methods Clinical data of 255 patients with histology-proven non-metastatic NPC received 4F-CRT were enrolled in the study. Patients received definitive radiotherapy with 6 MV Xrays,using conventional fraction at 2 Gy daily,5 fractions per week. Among them,231 patients of Ⅱ-ⅣB stage received cisplatin-based chemotherapy. Kaplan-Meier method was used for survival analysis,and Log-rank test was used to compare the survival difference. Multivariate analysis using Cox proportional hazard model was performed to analyze the factors related to prognosis of patients. Results The median follow-up time was 43 months（ 8- 79 months）. The 3-year and 5-year local control rates,disease-free survival rates and overall survival rates were 83. 3%,82. 0%,83. 8% and 76. 1%,73. 2%,76. 3%,respectively. Univariate analysis showed that TNM stage（ P〈0. 01）,T-stage（ P〈0. 01）,N-stage（ P = 0. 001）,and short term effect（ P = 0. 025） were all related to disease prognosis. Multivariate analysis indicated that age（ P =0. 004）,T-stage（ P〈0. 01）,N-stage（ P〈0. 01）,and combined chemotherapy（ P = 0. 04） were independent prognostic factors of patients. The major adverse effects were grade Ⅰ- Ⅱ mucosis and leukocytopenia. Conclusion The long-term efficacy of 4F-CRT is satisfactory and its toxicities are tolerable for NPC patient; combined chemotherapy,T-stage,N-stage and age are independent factors of disease prognosis.