湘西地区鼻咽癌调强放射治疗失败模式及相关因素分析

The failure patterns and related factors of nasopharyngeal carcinoma treated by intensity modulated radiation therapy in Xiangxi area

目的分析湘西地区鼻咽癌调强放射治疗的失败模式及相关因素,为提高鼻咽癌治疗疗效提供依据。方法选取2012年12月至2015年6月吉首大学第一附属医院收治的107例初治无远处转移鼻咽癌患者,统计患者的无局部复发生存率、无远处转移生存率、无进展生存率,采用K-M法进行生存分析,Log rank法检验并单因素分析,单因素分析中有统计学意义的因素纳入Cox回归模型进行多因素分析。结果107例鼻咽癌患者中40例出现肿瘤进展,其中局部复发14例(13.1%),远处转移33例(30.8%)。单因素分析显示不同年龄和T分期的无局部复发生存率差异有统计学意义(P<0.05),不同性别、年龄、糖尿病史、吸烟史、T分期、N分期、临床分期、治疗模式的无远处转移生存率和无进展生存率差异有统计学意义(P<0.05)。多因素分析显示年龄、T分期是无局部复发生存的独立预后因素(P<0.05),年龄、T分期、N分期是无远处转移生存的独立预后因素(P<0.05),年龄、糖尿病、T分期、N分期为无进展生存的独立预后因素(P<0.05)。结论远处转移仍为鼻咽癌治疗失败的主要模式,治疗前患者的年龄、T分期、N分期是影响治疗疗效的重要因素。

Objective To analyze the failure patterns and related factors of intensity modulated radiation therapy(IMRT)for nasopharyngeal carcinoma(NPC)in Xiangxi.Methods 107 patients with nasopharyngeal carcinoma without distant metastasis were selected from December 2012 to June 2015 in the first affiliated hospital of Jishou University.Locoreginal recurrence-fee survival rate(LRFS),distant metastasis-free survival rate(DMFS)and progression-free survival(FPS)rate were collected.The survival rate was analyzed by Kaplan-Meier method,univariate analysis was analyzed by Logrank method,and multivariate analysis was analyzed by Cox regression.Results Tumor progression occurred in 40 cases of 107 patients with nasopharyngeal carcinoma.Among them,14 cases(13.1%)had local recurrence and 33 cases(30.8%)had distant metastasis.Univariate analysis showed that there was significant difference in LRFS between different ages and T staging(P<0.05).There was significant difference in DMFS and PFS between different gender,ages,diabete history,smoking history,T staging,N stage,clinical stage and treatment mode(P<0.05).Multivariate analysis showed that age and T staging were independent prognostic factors for LRFS.Age,T staging and N staging were independent prognostic factors for DMFS.Age,diabetes,T staging,and N staging were independent prognostic factors for PFS(P<0.05).Conclusions Distant metastasis is still the main model of treatment failure of NPC.Age,T staging and N staging before treatment are the significant prognostic factors.