N2～3期局部晚期鼻咽癌不同新辅助化疗疗程预后分析

Prognostic Effects of Different Courses of Neoadjuvant Chemotherapy on Stage N2-3 Locally Advanced Nasopharyngeal Carcinoma

目的探讨不同新辅助化疗(NCT)疗程对N2～3期局部晚期鼻咽癌的预后影响。方法回顾性分析2012—2013年收治的270例N2～3期局部晚期鼻咽癌行新辅助化疗+同步放化疗或单纯同步放化疗患者的一般临床资料,全组NCT≥3程、NCT=1～2程、NCT=0程患者分别为84例、106例和80例。Kaplan-Meier法计算生存率并行Logrank法检验,Cox单、多因素分析无远处转移生存影响因素。结果全组中位随访时间63月(6～75月)。全组5年总生存(5-OS)、无瘤生存(5-DFS)、无局部复发生存(5-LRFS)和无远处转移生存率(5-DMFS)分别为78.4%、77.8%、97.7%和79.5%。三组5-OS分别为88.1%、78.8%和73.5%(P=0.03);三组5-DFS分别为89.3%、74.0%和72.3%(P=0.021),三组5-DMFS分别为89.3%、76.6%和74.5%(P=0.031),三组5-LRFS差异无统计学意义(P=0.535);单、多因素分析提示新辅助化疗疗程、N分期、年龄均是治疗后有无转移的独立预后因素。结论N2～3期局部晚期鼻咽癌患者行NCT≥3程诱导化疗+同步放化疗可明显提高总生存期、降低远处转移率。

Objective To investigate and compare the prognostic effects of different courses of neoadjuvant chemotherapy(NCT) on patients with clinical stage N2-3 locally advanced nasopharyngeal carcinoma.Methods We retrospectively reviewed the clinical data of 270 patients with locally advanced nasopharyngeal carcinoma(cT1-4 N2-3) who were treated with NCT followed by concurrent chemoradiotherapy(CCRT) or only CCRT from 2012 to 2013. Patients were classified into three groups: NCT≥3(n=84, 31.1%), NCT=2(n=106, 39.3%) and NCT=0(n=80, 29.6%). The survival rate was calculated by Kaplan-Meier and examined by Log rank test. Univariate and multivariate analyses of the distant metastasis free survival(DMFS) factors was conducted using Cox proportional hazard models. Results The median follow-up time was 63 months(6-75 months). For the whole group, 5-year overall survival(5-OS), 5-year disease free survival(5-DFS),5-year local recurrence free survival(5-LRFS) and 5-year distant metastasis free survival(5-DMFS) were78.4%, 77.8%, 97.7% and 79.5%, respectively. For NCT≥3, NCT=1-2 and NCT=0 groups, 5-OS were 88.1%,78.8% and 73.5%, respectively(P=0.03);5-DFS were 89.3%, 74.0% and 72.3%, respectively(P=0.021);5-DMFS were 89.3%, 76.6% and 74.5%, respectively(P=0.031);5-LRFS had no statistically significant difference among the three groups(P=0.535). Univariate and multivariate analyses suggested that neoadjuvant chemotherapy course, N stage and age were all independent prognostic factors. Conclusion More than three courses of NCT before CCRT could improve overall survival and reduce distant metastases rate in stage N2-3 locally advanced nasopharyngeal carcinoma patients.