寡转移状态下初治鼻咽癌的预后及治疗模式探讨

Prognosis and treatment of newly diagnosed nasopharyngeal carcinoma with oligometastases

目的：寡转移状态是鼻咽癌转移的一个特殊阶段，本研究主要探讨其预后因素及治疗模式。方法2002—2010年共149例寡转移状态下初治鼻咽癌患者纳入研究，其中合并骨转移、肝转移、肺转移分别为94、32、22例，转移灶1个、2～5个分别为51、98例。所有患者均接受了以铂类为基础联合化疗，中位化疗周期为5个（1～12个），其中115例患者接受原发灶放疗，57例接受转移灶局部处理。将患者临床特点、肿瘤状态及治疗模式等因素纳入生存分析中。 Kaplan.Meier法计算OS，单因素分析及差异检验采用Logrank法，Cox模型多因素分析。结果中位生存时间为31个月（2～144个月），所有患者3、5年OS 率分别为52.7％、37.7％。化疗后转移灶 CR＋PR、SD、PD 率分别为59.7％、31.5％、5.4％，近期疗效主要与转移灶数目（ P＝0.01）、化疗疗程（ P＝0.00）相关。影响患者OS因素包括合并肝转移（ P＝0.00）、乳酸脱氢酶＞245 IU／L （ P＝0.00）、化疗疗效包括SD及PD （ P＝0.00）、原发灶未接受放疗（ P＝0.01）。原发灶接受放疗者5年OS为46.2％，未接受者无5年生存。结论寡转移是初治转移鼻咽癌预后相对较好的一个亚组，其不良预后因素包括乳酸脱氢酶＞245 IU／L、肝转移、化疗疗效包括SD及PD和原发灶无放疗等，原发灶放疗能进一步提高寡转移状态下初治鼻咽癌患者OS。

Objective To investigate the prognostic factors and treatment modes for nasopharyngeal carcinoma with oligometastases. Methods A total of 149 patients newly diagnosed with nasopharyngeal carcinoma and oligometastases from 2002 to 2010 were enrolled as subjects. In those patients, 94 had bone metastases, 32 liver metastases, and 22 lung metastases;51 had only one metastatic site and 98 had 2.5 metastatic sites. All the patients were treated with cisplatinum.based commination chemotherapy. The median number of cycles of chemotherapy was 5（1.12）. In those patients, 115 received radiation to the primary tumor and 57 received local radiotherapy to metastatic sites. A survival analysis was performed on clinical characteristics, tumor status, and treatment mode. The Kaplan.Meier method was used to calculate the overall survival （ OS） rate. The log.rank test was used to analyze the difference and perform the univariate analysis. The Cox regression model was used for multivariate analysis. Results In all patients, the median OS time was 31 months （ 2.144 months）;the 3.and 5.year OS rates were 52.7% and 37.7%, respectively;59.7%, 31.5%, and 5.4% of patients had complete response/partial response, stable disease （ SD） , and progressive disease （ PD） , respectively. The short.term treatment outcomes were associated with the numbers of metastatic sites and chemotherapy cycles （ P= 0.01;P= 0.00 ） . Liver metastases, a level of lactate dehydrogenase （ LDH ） higher than 245 IU/L, a poor response to chemotherapy （ SD/PD ） , and no radiotherapy for primary tumor were prognostic factors for poor OS （ P=0.00;P=0.00;P=0.00;P=0.01） . The 5.year OS rate of patients undergoing radiotherapy for primary tumor was 46.2% and no patients survived more than 5 years without radiotherapy for the primary tumor. Conclusions Patients newly diagnosed with nasopharyngeal carcinoma and oligometastases have relatively good prognosis. A level of LDH higher than 245 IU/L, liver metastases, a poor response to chemotherapy （SD/PD）, and no radiotherapy for the primary tumor are negative prognostic factors. Radiotherapy for the primary tumor can further improve the OS in patients newly diagnosed with nasopharyngeal carcinoma and oligometastases.