基于磁共振成像及调强放疗的鼻咽癌副鼻窦侵犯的预后分析

Analysis of Prognostic Value of Paranasal Sinus Invasion in Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Radiotherapy Based on MRI

目的探讨基于磁共振及调强放疗(IMRT)的鼻咽癌副鼻窦侵犯的预后分析及其在分期中的意义。方法回顾性分析791例经活检证实、无远处转移、未经治疗的鼻咽癌患者的MRI数据和临床资料。所有病例均按国际抗癌联盟(UICC)/美国癌症联合委员会(AJCC)第8版进行分期。采用Kaplan-Meier法对5年总生存率(OS)、无局部复发生存率(LRFS)、无远处转移生存率(DMFS)进行分析,并用Log-rank方法检验。应用Cox比例风险回归模型进行多因素生存分析。结果鼻咽癌副鼻窦侵犯率为13.6%(108/791),蝶窦、筛窦、上颌窦的侵犯率分别为13.0%(103/791)、3.7%(29/791)、1.5%(12/791)。多因素分析显示,副鼻窦侵犯是OS、DMFS的独立预后因素(P<0.001),而蝶窦侵犯是LRFS的独立预后因素(P<0.001)。仅有蝶窦侵犯与有上颌窦和/或筛窦侵犯两组之间的5年OS、DMFS、LRFS差异无统计学意义(P分别为0.795、0.263、0.452)。T3期有副鼻窦侵犯的5年OS、DMFS、LRFS与T4期相似,T3期有副鼻窦侵犯的5年OS较T3期无副鼻窦侵犯的预后差,但T3期有副鼻窦侵犯的5年DMFS、LRFS与T3期无副鼻窦侵犯差异无统计学意义。结论副鼻窦侵犯是IMRT鼻咽癌患者的重要独立预后不良因素,蝶窦侵犯与筛窦或上颌窦侵犯之间的预后无明显差异,有副鼻窦侵犯的比没有副鼻窦侵犯的患者预后差。鼻咽癌副鼻窦侵犯的T分期有待进一步探讨。

Objective To evaluate the prognostic value and T-stage subclassifications for paranasal sinus invasion in nasopharyngeal carcinoma(NPC) patients undergoing magnetic resonance imaging(MRI) and intensity-modulated radiotherapy(IMRT). Methods MRI data and medical records of 791 patients with biopsy-proven,non-metastatic untreated NPC who were then treated with IMRT, were analyzed retrospectively. All cases were restaged according to the eighth edition of UICC/AJCC staging system criteria. The 5-year overall survival(OS),local relapse-free survival(LRFS),and distant metastasis-free survival(DMFS) were analyzed by the Kaplan-Meier method,and the differences were compared by using the log-rank test. The Cox proportional hazard model was used for multivariate prognostic analyses. Results Of the 791 NPC patients analyzed, paranasal sinuses were involved in 108(13.6%) cases,of which sphenoid sinus,ethmoid sinus and maxillary sinus were affected in 103(13.0%),29(3.7%),12(1.5%),respectively. Multivariate analyses indicated that paranasal sinus invasion was an independent prognostic factor for the OS,DMFS(P<0.001),and sphenoid sinus invasion was an independent prognostic factor for the LRFS(P<0.001). There were no significant differences in OS, DMFS,LRFS between patients with sphenoid sinus invasion alone and those with maxillary sinus and/or ethmoid sinus invasion(P value was 0.795,0.263,0.452,respectively). T3 patients with paranasal sinus invasion had similar 5-year OS(76.2% vs 78.1%,P=0.904),DMFS(78.3% vs 79.9%,P=0.955) as T4 patients,and had poorer OS(76.2% vs 91.5%,P=0.005) than T3 patients without paranasal sinus invasion. However,There was no significant difference in the 5-year DMFS(78.3% vs 89.7%,P=0.115)and LRFS(81.5% vs 90.4%,P=0.145)between T3 patients with and without paranasal sinus invasion. Conclusion Paranasal sinus invasion is an independent negative prognostic factor for NPC,regardless of which sinus is involved. T3 NPC patients involving the paranasal sinus present with worse survival outcome than those with no invasion. However,there is a need to investigate the feasibility of classifying the T-staging category in future by a larger cohort study.