基于第八版AJCC分期的早期鼻咽癌调强放疗的疗效分析

Treatment of Early-Stage Nasopharyngeal Carcinoma with Intensity-Modulated Radiotherapy According to the 8th Edition of AJCC/UICC Staging System

目的分析基于第八版美国癌症联合委员会(AJCC)癌症分期的Ⅰ—Ⅱ期鼻咽癌患者的调强放射治疗(放疗)的长期疗效及不同T与N分期对预后的影响。方法收集接受调强放疗的90例早期(T1—2N0—1M0期,第八版AJCC分期)鼻咽癌初治患者的临床资料做回顾性分析。结果中位随访50个月,全组5年总生存率为94.1%,肿瘤相关生存率为96.5%,无局部复发生存率为96.5%,无远处转移生存率为94.2%,无瘤生存率为89.6%。T1、T2期5年无局部复发生存率分别为97.5%和95.8%(χ2=0.341,P=0.559)。T1N0、T2N0、T1N1和T2N1期的5年无远处转移生存率分别为100.0%、91.7%、100.0%和88.5%(χ2=4.536,P=0.209)。多因素分析显示年龄、性别、T分期、N分期、化疗均与无局部复发生存率、无远处转移生存率以及肿瘤相关生存率无关。结论 IMRT治疗早期鼻咽癌疗效好,但T2N1期患者远处转移风险偏高,化疗能否获益需要进一步探讨。

Objective To analyze the long-term effect intensity-modulated radiotherapy(IMRT)on stageⅠ-Ⅱ nasopharyngeal carcinoma(NPC)according to the 8 th the edition of AJCC/UICC staging system,and to investigate the impact of different T and N stages on the prognosis.Methods Clinical data of 90 patients with early-stage NPC(T1-2 N0-1 M0,the 8 th the edition of AJCC/UICC staging classification)who were treated with IMRT were analyzed retrospectively.Results The median follow-up time was 50 months.The 5-year overall survival(OS),disease-specific survival(DSS),local recurrence-free survival(LRFS),distant metastasis-free survival(DMFS)and disease-free survival(DFS)rates were 94.1%,96.5%,96.5%,94.2% and 89.6%,respectively.The 5-year LRFS rate was 97.5%in patients with T1 lesions and 95.8%in patients with T2 lesions(χ2=0.341,P=0.559).The 5-year DMFS rate was 100.0% in patients with T1 N0 tumors,91.7%in patients with T2 N0 tumors,100.0%in patients with T1 N1 tumors and88.5%in patients with T2 N1 tumors(χ2=4.536,P=0.209).Multivariate analysis showed that the age,gender,T stage,N stage and chemotherapy were not associated with LRFS,DMFS and DSS.Conclusion The IMRT is effective for early-stage NPC.However,patients with T2 N1 tumors have a high risk of distant metastasis.Therefore,chemotherapy for early-stage NPC should be studied further.