N3鼻咽癌患者常规放疗同期化疗的疗效评价与预后因素分析

Analysis of Clinical Efficacy and Prognostic Factors of Conventional Radiotherapy Concurrent Chemotherapy in Patients with N3 Nasopharyngeal Carcinoma

目的探讨放疗同步PF(顺铂+氟尿嘧啶)方案治疗N3鼻咽癌的临床疗效及预后因素。方法将85例N3鼻咽癌患者随机分为2组,治疗组43例给予放射治疗同步PF方案化疗,对照组42例给予放射治疗,比较2组的治疗情况并分析预后影响因素。结果治疗组39例、对照组38例患者进入最终研究,2组患者一般资料差异无统计学意义(P>0.05)。治疗结束后3个月,治疗组和对照组完全缓解率和客观有效率分别为87.3%vs.65.8%,92.3%vs.71.1%,颈部淋巴结的完全缓解率和客观有效率分别为82.1%vs.57.9%,87.2%vs.63.2%,2组比较均有显著统计学差异(P=0.027,P=0.016,P=0.021,P=0.006)。治疗组和对照组的1年和2年局部复发率分别为7.7%vs.28.9%,17.9%vs.39.5%;1年和2年远处转移率分别为7.7%vs.26.3%,12.8%vs.31.6%;1年和2年生存率分别为94.9%vs.78.9%,82.1%vs.60.5%,2组1年和2年局部复发率、远处转移率和生存率比较均有显著统计学差异(P<0.05)。治疗组的白细胞下降、贫血及Ⅲ+Ⅳ度口腔黏膜炎的发生率明显高于对照组,但对症治疗后均好转。多因素分析结果提示年龄及T分期是影响鼻咽癌患者预后的主要危险因素。结论同步放化疗能提高N3鼻咽癌的近期疗效,降低局部复发率和远处转移率,提高远期生存率,而年龄和T分期是影响鼻咽癌预后的主要因素。

Objective To evaluate the effect and prognostic factors analysis of conventional radiotherapy concurrent PF(cisplatin and fluorouracil)regimen in patients with N3 nasopharyngeal carcinoma.Methods 85 cases of N3 nasopharyngeal carcinoma were randomly divided into 2 groups.43 patients in the treatment group were treated with radiotherapy synchronized PF chemotherapy,42 cases in the control group were treated with radiotherapy,compared the treatment of the 2 groups and analyzed the prognostic factors.Results 39 cases in treatment group and 38 patients in the control group entered the final study,there were not statistically significant difference in the general information of the two groups(P>0.05).The complete remission rate and objective response rates of rhinitis lesions of treatment group and the control group were 87.3%vs.65.8%,92.3%vs.71.1%,the complete remission rate and objective response rates of neck lymph nodes of 2 groups were 82.1%vs.57.9%,87.2%vs.63.2%,there were significant statistically difference in the 2 groups(P=0.027,P=0.016,P=0.021,P=0.006).1-year and 2-year local recurrence rate in the treatment group and the control group were 7.7%vs.17.9%28.9%vs.39.5%;1-year and 2-year distant metastasis rate were 7.7%vs.12.8%,26.3%,the vs.31.6%;1-year and 2-year survival rate of 94.9%vs.82.1%78.9%vs.60.5%,there were significant statistically differences between the 2 groups in local recurrence,distant metastasis and survival rates(P<0.05).The incidence of leukopenia,anemia andⅢ+Ⅳdegrees of oral mucositis of treatment group were significantly higher than those in the control group,but were improved after symptomatic treatment.Multivariate analysis results suggest that age and T stage were the main risk factors affecting the prognosis of patients with nasopharyngeal carcinoma.Conclusion Synchronous chemoradiotherapy can improve the term effect,reduce the rate of local recurrence and distant metastasis rates,and improve long-term survival of N3 nasopharyngeal carcinoma,and the age and T stage is the main factor to affect the prognosis of nasopharyngeal carcinoma.