第七版和第八版AJCC/UICC分期的T4期鼻咽癌调强放疗远期疗效比较

A Retrospective Study Comparing Outcomes of the Seventh Edition AJCC/UICC Staging System Stage T4 Nasopharyngeal Carcinoma Patients with Those of the Eighth Edition Stage T4 Patients after Intensity-modulated Radiotherapy

目的比较第七版和第八版AJCC/UICC分期的T4期鼻咽癌调强放疗远期疗效,探讨第八版AJCC/UICC分期的合理性和T4期鼻咽癌患者的预后因素。方法 155例初治无远处转移T4期(第七版AJCC分期)鼻咽癌患者根据第八版AJCC/UICC分期标准重新分期,T4期患者为123例,比较两组的远期疗效。结果 155例T4期(第七版分期)患者5年总生存率为72.6%,无局部复发生存率为77.2%,无远处转移生存率为69.8%,无病生存率为51.0%。根据第八版AJCC/UICC分期,4例由T4期降为T2期,28例由T4期降为T3期,T4期共123例,5年无局部复发生存率分别为100%,92.6%、72.9%。123例T4期(第八版分期)患者5年总生存率为68.9%,无远处转移生存率为73.1%,无病生存率为49.5%。第七版AJCC分期为T4期患者进行多因素分析,显示性别、颅神经是否受侵以及化疗对无局部复发生存率有影响,N分期对无远处转移生存率有影响,性别对总生存率有影响。对第八版AJCC分期为T4期患者进行多因素分析,显示性别、化疗对无局部复发生存率有影响,N分期对无远处转移生存率有影响,性别对总生存率有影响。结论第八版AJCC/UICC将原发灶侵犯范围超过翼外肌外缘归为T4期,而单纯翼内肌和(或)翼外肌受侵降期为T2期,较第七版AJCC分期更加合理。颅神经是否受侵与第八版AJCC分期的T4期患者预后无关。

Objective To compare the treatment result of intensity-modulated radiotherapy（ IMRT） for patients with the AJCC/UICC staging system（ 7 th edition） Stage T4 nasopharyngeal carcinoma（ NPC） with those of the 8 th edition Stage T4 patients,and explore the prognostic factors. Methods Clinical data of 155 patients with the seventh edition AJCC/UICC staging system Stage T4 NPC treated by IMRT were reviewed. All NPC cases were restaged according the eighth edition of the AJCC staging system. Results For NPC patients with the AJCC/UICC staging system（ 7 th edition） Stage T4,the 5-year estimated overall survival（ OS）,local recurrence-free survival（ LRFS）,distant metastasis-free survival（ DMFS） and disease-free survival（ DFS）rate were 72. 6%,77. 2%,69. 8% and 51. 0%,respectively. There were 4 patients with the seventh edition AJCC/UICC staging system Stage T4 down-staging to T2,28 patients down-staging to T3,the remaining were still Stage T4 according the eighth edition AJCC/UICC staging system. For the 3 groups,the 5-year local recurrence-free survival（ LFRS） rates were 100%,92. 6% 、72. 9%. For NPC patients with the AJCC/UICC staging system（ 8 th edition） Stage T4,the 5-year estimated overall survival（ OS）,distant metastasis-free survival（ DMFS） and disease-free survival（ DFS） rate were 68. 9%,73. 1% and 49. 5%,respectively.Multivariate analysis showed that gender,cranial nerve involvement and chemotherapy was associated with LRFS,N stage was an independent prognostic factor for DMFS and Gender was correlated with DSS in the seventh edition AJCC/UICC staging system.Multivariate analysis showed that gender and chemotherapy was associated with LRFS,N stage was an independent prognostic factor for DMFS and Gender was correlated with DSS in the eighth edition AJCC/UICC staging system. Conclusion It is reasonable that extensive infiltration beyond the lateral surface of the lateral pterygoid muscle is defined as T4,and the seventh edition AJCC/UICC staging system Stage T4 with only medial/lateral pterygoid muscle is changed to T2 according to the eighth edition AJCC/UICC staging system. Cranial nerve involvement is not associated with the prognosis of patients with the eighth edition AJCC/UICC staging system Stage T4.