IMRT时代鼻咽癌临床分期的降期新建议研究

New suggestion for clinical downstaging of nasopharyngeal carcinoma in the era of intensitymodulated radiotherapy

目的 在不改变目前T、N、M分期定义基础上,提出适用于IMRT时代鼻咽癌临床分期的降期新建议。方法 回顾分析中山大学附属肿瘤医院2002—2006年536例鼻咽癌病例,采用Kaplan-Meier计算DSS率并Logrank检验,Cox法计算各亚组DSS风险比。结果 依据第7版UICC/AJCC分期系统,Ⅰ—Ⅲ期非T3N2M0期患者5年DSS均在85%以上,ⅣA、ⅣB期的分别为71.8%、46.2%（P=0.171）,而ⅣC期的仅为24.0%。Ⅲ期患者中非T3N2M0期患者5年DSS （91.5%）高于T3N2M0期患者（78.6%）（P=0.042）。T3N2M0期患者DSS经临床综合评估与ⅣA—ⅣB期患者相似。新Ⅰ期包括T1-3N0-1M0和T1-2N2M0,新Ⅱ期包括T3N2M0、T4N0-2M0和 TxN3M0期,新Ⅲ期包括TxNxM1期,新Ⅰ、Ⅱ、Ⅲ期的5年DSS分别为93.3%、72.7%、24.0%（P=0.000）,相比于新Ⅰ期,新Ⅱ、Ⅲ期的5年DSS风险比分别为4.01、16.76。结论 IMRT时代把鼻咽癌临床分期降为3个组可以更好地区分预后及指导临床治疗。

Objective To propose a new suggestion for the clinical downstaging of nasopharyngeal carcinoma （NPC） in the era of intensity-modulated radiotherapy （IMRT） without changing the current T,N,and M staging system. Methods We reviewed the records of 536 NPC patients treated in Sun Yat-Sen University Cancer Center from January 2002 to December 2006.The Kaplan-Meier method was used to calculate the disease-specific survival （DSS） rate,and the log-rank test was used for survival differenceanalysis. The Cox regression model was used to calculate the hazard ratio （HR） of each subset. ResultsAccording to the 7th edition of UICC/AJCC staging system,the 5-year DSS rates of stage Ⅰ-Ⅲ patients （except T3N2M0） were all more than 85%（P〉0.05）,those of stage ⅣA and ⅣB patients were 71.8% and 46.2%,respectively （P=0.171）,and that of stage ⅠVC patients was only 24.0%.In stage Ⅲ,the 5-year DSS rate of non-T3N2M0 patients （91.5%） was significantly higher than that of T3N2M0 patients （78.6%）（P=0.042）,but there was no significant difference in DSS between T3N2M0 patients and stage ⅣA and ⅣB patients. Based on the above results,new stage Ⅰ included T1-3N0-1M0 and T1-2N2M0,new stage Ⅱ included T3N2M0,T4N0-2M0,and TxN3M0,and new stage Ⅲ included TxNxM1.The 5-year DSS rates of new stage Ⅰ,Ⅱ,and Ⅲ patients were 93.3%,72.7%,and 24.0%,respectively （P=0.000）.Compared with new stage Ⅰ patients,new stage Ⅱ and Ⅲ patients had HRs of 4.01 and 16.76,respectively,for 5-year DSS. Conclusions In the era of IMRT,the new clinical staging system （stages Ⅰ,Ⅱ,and Ⅲ） helps with prognostic evaluation and clinical treatment.