局部区域晚期鼻咽癌患者治疗后失败风险随时间变化的探讨

Analysis of Changes in Failure Risk Over Time of Patients with Locoregionally Advanced Nasopharyngeal Carcinoma

【目的】探讨局部区域晚期鼻咽癌患者治疗后的失败风险随时间变化的规律,为个体化随访提供参考。【方法】研究纳入了2009-2010年556例接受调强放疗的局部区域晚期鼻咽癌患者,使用寿命表法计算无失败生存率及年度失败风险率,用率差可信区间评估不同失败风险率差异的大小。【结果】本研究中位随访83个月,至最后随访日期,共有119例患者发生了治疗失败事件,患者5年无失败生存率为80.6%,失败风险曲线在前两年上升达到峰值,随后缓慢下降。各期峰值年份与随后年份的失败风险发生率比较结果如下:Ⅲ期患者第2年比第5年高3.2%(P<0.05);ⅣB期患者第2年比第4年高18.4%(P<0.05),其余结果无统计学差异。此外,ⅣB期患者的失败风险在前两年显著高于Ⅲ期患者,在第二年显著高于ⅣA期患者。【结论】局部区域晚期鼻咽癌患者的失败风险曲线在第2年达到相对峰值。Ⅲ期患者建议在治疗后3-4年内保持相对高的随访频率;ⅣA期患者在3-5年内不建议降低随访频率;ⅣB期患者在2-3年内不建议降低随访频率,并且在前两年内需要相对其他期别患者更高的随访频率。

【Objective】This study aims to investigate the changes in risk of disease failure in patients with locoregionally advanced nasopharyngeal carcinoma（NPC）after treatment over time and provide reference for individualized followup.【Methods】556 patients receiving intensity-modulated radiotherapy（IMRT）from 2009 to 2010 were analyzed. The failure free survival（FFS）and annual hazard rates of disease failure were estimated using the life-table method. We also used the difference confidence interval to evaluate the difference between different failure risk rates.【Results】The median follow-up in study was 83 months. A total of 119 patients experienced the treatment failure during the follow-up period. The 5-year failure-free survival rate of the whole cohort was 80.6% and the curve of failure risk showed an increase in the first two years and a slow decline after two years. The comparison of the rates of failure risk in different stages between the peak year and the subsequent years were as follow：For patients with stage Ⅲ,failure risk rate of the second year was significantly 3.2% higher than that in the fifth year;Rate of the second year was significantly 18.4%higher than that in the fourth year for patients with stage ⅣB. No significantly difference was found in other results. Additionally,the risks of failure in patients with ⅣB were significantly higher than that in patients with stage Ⅲ in the firsttwo years and in patients with stage ⅣA in the second year.【Conclusion】The curve of failure risk for patients with locoregionally advanced NPC reached a relative peak in the second year.It is recommended that patients with stage Ⅲ maintain a relatively high follow-up frequency within 3-4 years after treatment;Patients in stage ⅣA were not recommended to reduce the frequency of follow-up within 3-5 years;It was recommended that the frequency of follow-up could not be reduced within 2-3 years,and should be given a more intensive follow-up strategy than patients with stage Ⅲ-ⅣA in the first two years.