年轻成年鼻咽癌调强放疗临床疗效及预后分析

Clinical Efficacy and Prognostic Analysis of Intensity-modulated Radiotherapy(IMRT) for Nasopharyngeal Carcinoma in Young Adult Patients

目的:探讨年轻成年鼻咽癌患者经调强放疗(intensity-modulated radiotherapy,IMRT)的临床疗效及预后分析。方法:回顾性分析2010年1月~2013年12月间经病理证实的初治无转移、年龄20~39岁鼻咽癌患者165例的临床资料。结果:共纳入165例患者分析,全组患者中位随访时间65个月(4~96个月)。全组患者5年总生存率(OS)、无远处转移生存率(DMFS)、无进展生存率(PFS)及局部区域无复发生存率(LRRFS)分别为85.9%、82.4%、76.4%、92.4%。单因素分析结果显示影响OS的因素有EBV-DNA拷贝数(P=0.044)、N分期(P=0.001)、顺铂累积剂量(P=0.039);影响DMFS的有EBV-DNA拷贝数(P=0.011)、T分期(P=0.010)、N分期(P=0.005);影响PFS的是病理类型(P=0.017)。多因素分析结果示,N分期是影响OS(P=0.011)和DMFS(P=0.008)的独立预后因素;顺铂累积剂量是影响OS(P=0.032)的独立预后因素;3级以上急性不良反应主要包括骨髓抑制(70.9%)、口腔黏膜炎(46.7%)、吞咽困难(18.2%)、放射性皮炎(17%)和口干症状(6.7%);慢性不良反应主要为1~2级的口干症状(65.5%)、听力下降(38.8%)、颈部纤维化(17%)、视力下降(9%)等。结论:年轻成年鼻咽癌患者在调强放疗模式下可获得较好的局部区域控制率及总生存率,且不良反应较轻、可耐受;其治疗失败以远处转移为主,N分期及顺铂累积剂量是主要的预后因素。

Objective： To evaluate the treatment outcome and prognostic factors of intensity modulated radiation therapy for young adult nasopharyngeal carcinoma. Methods： The 165 nasopharyngeal carcinoma patients diagnosed by histopathology and aged between 20 and 39 years old who were treated by IMRT at Sichuan Cancer hospital from January 2010 to December 2013 were reviewed and include in data analyzed. Results： A total of 165 patients were included in the analysis. The median follow-up period was 65 months（ 4 ~ 96 months）. The 5-year overall survival（ OS）,distant metastasis free survival（ DMFS）,progression-free survival（ DFS） and local-regional reccurence free survival（ LRRFS） were 85. 9%,82. 4%,76. 4% and 92. 4%. By univariate analysis,the EBV-DNA level（ P = 0. 044）,N stage（ P = 0. 001） and cumulative cisplatin dose（ P = 0. 039） was the prognostic factors for OS; EBV-DNA level（ P = 0. 011）,T stage（ P =0. 010） and N stage（ P = 0. 005） was the prognostic factors for DMFS; pathological type（ P = 0. 017） was the prognostic factors for PFS. In multivariate factors analyses,N stage was the significant prognosticator for OS（ P = 0. 011）,DMFS（ P = 0. 008） and Cumulative cisplatin 200 mg/m^2 was an independent prognostic factor for OS（ P = 0. 032）. The most common acute toxicities over three degrees were myelosuppression（ 70. 9%）,mucositis（ 46. 7%）,leukopenia（ 18. 2%）,skin reactions（ 17%）,xerostomia（ 6. 7%）. The most frequent late toxicities were xerostomia（ 65. 5%）,hearing impairment（ 38. 8%）,neck fibrosis（ 17%）. Conclusion： IMRT seems to lengthen 5-year OS and to achieve a reasonable local-regional control in young adults nasopharyngeal carcinoma patients,with acceptable treatment relative toxicities. The treatment failed mainly by distant metastasis. N classification and cumulative cisplatin dose were the related prognostic factors influencing the long-term curative effect of IMRT of the young adults with nasopharyngeal carcinoma.