序贯放化疗后辅助化疗治疗局部晚期鼻咽癌的疗效分析

Efficacy of Adjuvant Chemotherapy on Patients with Locoregionally Advanced Nasopharyngeal Carcinoma after Undergoing Sequential Chemoradiotherapy

目的评价新辅助化疗（NACT）序贯调强放疗（IMRT）之后的辅助化疗（AC）对局部晚期鼻咽癌的临床疗效。方法收集初治的局部晚期鼻咽癌172例,其中NACT＋IMRT组94例、NACT＋IMRT＋AC组78例。应用Kaplan-Meier法评估患者的生存率,Cox回归模型进行多因素分析。结果NACT＋IMRT组与NACT＋IMRT＋AC组的3年总生存率（OS）、无进展生存率（PFS）、无复发生存率（RFS）、无远处转移生存率（DMFS）分别为86.66%vs.84.47%,77.38%vs.75.31%,92.65%vs.86.00%,83.20%vs.88.64%,2组比较差别均无统计学意义（P〉0.05）。对于N3及ⅣA期患者,AC延长了无远处转移生存,但是增加了3-4级骨髓抑制及听力下降的发生率（P〈0.05）。N分期是DMFS的独立预后因素（P〈0.05）。结论 NACT＋IMRT治疗后的AC对局部晚期鼻咽癌患者并没有增加生存获益,反而增加了毒副反应,但它可能有助于降低N3及ⅣA期患者的远处转移风险。

Objective To retrospectively study the efficacy of adjuvant chemotherapy（AC）following sequential chemoradiotherapy for patients with locoregionally advanced nasopharyngeal carcinoma. Methods 172 cases of locoregionally advanced nasopharyngeal carcinoma were reviewed,among them94 received neoadjuvant chemotherapy（NACT）followed by intensity modulated radiation therapy（IMRT）,while 78 received NACT plus IMRT followed by adjuvant chemotherapy（AC）. The survival rates were assessed by Kaplan-Meier analysis. The multivariate analysis was performed by using the Cox proportional hazards regression tests. Results The 3-year overall survival（OS）,progression-free survival（PFS）,recurrence-free survival（RFS）,and distant metastasis-free survival（DMFS）rate for the two groups（the NACT＋IMRT group vs NACT＋IMRT＋AC group）were 86.66% vs 84.47%,77.38% vs75.31%,92.65%vs 86.00%,and 83.20%vs 88.64%,respectively. There was no significant difference in all parameters between the two groups（P〉0.05）. A stratified analysis indicated that AC improved the DMFS in N3 and IVA stage patients. Compared with the NACT＋IMRT group,NACT＋IMRT＋AC significantly increased the occurrence rates of grade 3-4bone marrow suppression and hear loss（P〈0.05）. The N staging was an independent prognostic factor for DMFS（P〈0.05）. ConclusionThe addition of AC provide adds no survival benefit to patients with locoregionally advanced nasopharyngeal carcinoma after undergoing sequential chemoradiotherapy. However,AC seems to improve the DMFS for N3 or IVA stage patients.