鼻咽部肿瘤体积在中国西北非高发区鼻咽癌患者中的预后价值

The prognostic value of primary tumor volume in non-endemic patients with nasopharynx carcinoma in northwest China

目的探索鼻咽部肿瘤体积在中国西北非高发区鼻咽癌患者中的预后价值。方法将2004-2011年接受根治性放疗的393例鼻咽癌患者纳入本研究,所有患者均通过鼻咽部组织活检明确为鼻咽癌,观察总生存率和无远处转移生存率,采用ROC曲线确定肿瘤体积最佳界值,Kaplan-Meier比较患者生存差异,COX比例风险回归模型探索独立预后因素。结果患者5年总生存率和无远处转移生存率分别为74.3%和73.5%。根据肿瘤体积最佳界值将患者分为≤23mL组和>23mL组,≤23mL组患者5年总生存率和无远处转移生存率明显高于>23mL组,差异有统计学意义(P<0.05)。多因素分析显示病理类型为分化亚型、肿瘤体积>23mL、N2~3为影响患者总生存率和无远处转移生存率的独立预后因素。结论鼻咽部肿瘤体积是影响中国西北非高发区鼻咽癌患者生存的独立预后因素。

Objective To investigate the prognostic value of primary tumor volume in non-endemic patients with nasopharynx carcinoma in northwest China. Methods A total of 393 patients were enrolled in the study and all the patients had been identified with nasopharynx squamous cell carcinoma by biopsy. Overall survival （OS） and distant metastasis free survival （DMFS） were the primary endpoints. The cut-off of tumor volume was identified by ROC curves. Survival results were analyzed by the Kaplan-Meier curve. Independent prognostic factors were identified by COX proportional hazards regression model. Results The 5-year OS and DMFS for all the patients were 74.3% and 73.5%. 23 mL was considered as the optimal cut-off value according to the ROC curves, and then the patients were divided into two groups （≤23 mL and 〉23 mL）. Patients with tumor volume 423 mL had significantly better 5-year OS and DMFS than those with tumor volume 〉23 mL （P〈0. 05）. The independent prognostic factors for DMFS and OS included WHO histological type, tumor volume 〉23 mL and N2-3 （P〈 0.05）. Conclusion Primary tumor volume is an independent prognostic factor for survival of nasopharyngeal carcinoma patients in northwest China.