635例非高发区局部晚期鼻咽癌调强放疗的长期随访观察

The long-term survival outcomes of 635 patients with locoregionally advanced nasopharyngeal carcinoma treated with intensity-modulated radiation therapy in non endemic area

目的 探讨江苏省初治局部晚期（Ⅲ、ⅣA、ⅣB期）鼻咽癌患者调强放疗联合化疗治疗后长期生存情况及预后影响因素。方法 收集江苏省肿瘤医院放疗科2009年1月至2013年12月收治的局部晚期鼻咽癌635例进行回顾性分析。所有患者均接受调强放疗,其中604例患者接受了含铂方案为主的化疗。采用Kaplan-Meier法进行生存分析,用Log-rank检验和Cox比例风险回归模型分析局部晚期鼻咽癌患者的预后相关因素。结果 随访5~92个月,中位随访时间63.5个月。全组患者的5年局部无复发生存（LRFS）、区域无复发生存（RRFS）、无远处转移生存（DMFS）、无进展生存（DFS）、总生存（OS）率分别为88.4%、94.2%、79.2%、71.9%和76.3%。175例（27.6%）治疗失败,其中远处转移（131例,74.9%）是主要的治疗失败形式。T分期是LRFS的独立预后因素,临床分期、N分期和化疗是RRFS、DMFS、DFS及OS的独立预后因素。结论调强放疗提高了鼻咽癌患者的远期疗效。除了T、N分期是影响预后的重要因素外,化疗对预后也起到一定的作用。

Objective To evaluate the long-term survival outcomes and prognostic factors of locoregionally advanced （Ⅲ, Ⅳ A, Ⅳ B） nasopharyngeal carcinoma（NPC） patients treated with intensity-modulated radiation therapy （IMRT） plus chemotherapy in Jiangsu Province. Methods From January 2009 to December 2013, 635 locoregionally advanced NPC patients treated by IMRT and platinum-based chemotherapy were analyzed retrospectively. Survival data were calculated with a Kaplan-Meier method. Log-rank test and Cox proportional hazard regression model were performed to investigate the risk factors of prognosis. Results With a median fol- low-up of 63.5 months （ range 5-92 months ） , the 5-year local recurrence-free survival （ LRFS ） , regional recurrence-free survival （RRFS）, distant metastasis-free survival （DMFS）, disease-free survival （DFS） and overall survival （OS） rates were 88.4%, 94. 2%, 79. 2%, 71.9% and 76. 3%, respectively. Of the 635 patients, 175 （27. 6%） developed failure after treatment. Distant me- tastasis （n= 131, 74. 9%） was the major failure pattern after treatment. T stage was an independent prognostic factor for LRFS. N stage, clinical stage and chemotherapy were independent prognostic factors for RRFS, DMFS, DFS and OS. Conclusion IMRT pro- vides satisfactory long-term outcome for NPC. T and N stage are important prognostic factors, as well as chemotherapy.