鼻咽癌中国2008分期与2017修订版分期比较分析

Comparative analysis of prognostic value between the 2008 and the 2017 edition staging systems for NPC

目的比较鼻咽癌(NPC)中国2008分期与2017修订版的病例分布及生存曲线,评价新版分期对指导临床治疗、疗效评估及预后预测的临床价值。方法搜集行鼻咽及颈部MRI检查的未经治疗且具有完整复查资料的NPC 108例。按照NPC 2008分期及2017修订版标准,将所有病例行TNM分期,采用Kaplan-Meier计算各组病例的无局部复发生存率(LRFS)、无远处转移生存率(DMFS)及总生存率(OS)并行Log-rank检验。结果⑴以2017修订版为标准:12例患者由T3期调整T2期,1例患者由T4期调整T2期,7例患者由T1期调整T2期,3例患者由T2期调整T1期,2例由T4期调整T3期;1例患者由N2期调整为N3期,1例患者由N2期调整为N1期;⑵NPC 2008分期各N分期的DMFS(χ^(2)=6.430,P=0.040)、OS(χ^(2)=6.057,P=0.048)及2017修订版分期各N分期的DMFS(χ^(2)=7.121,P=0.028)及OS(χ^(2)=6.623,P=0.036)差异有统计学意义,而两种分期的N分期LRFS、T分期及临床分期的LRFS、DMFS及OS差异无统计学意义(P>0.05)。结论鼻咽癌2017修订版N分期更为简洁且对患者预后预测具有较高的临床价值,T分期可进一步简化。

Objective To compare patient distributions and prognostic value between the 2008 and the 2017 edition staging systems for nasopharyngeal carcinoma(NPC),and To evaluate the clinical value of the 2017 edition staging in guiding clinical treatment,efficacy evaluation and prognosis prediction.Methods A total of 108 untreated neonatal NPC were enrolled from December 1,2010 to December 31,2015,all patients underwent MRI scan.All cases were definited into the different TNM stage according to the 2008 and the 2017 edition staging systems for NPC,the Local recurrence-free(LRFS),Distant metastasis-free Survival(DMFS)and Overall survival(OS)were calculated by Kaplan-Meier method and conducted by Log-rank test in every group.Results(1)According to the 2017 edition staging,12 cases T3 were adjusted to T2,1 case T4 was adjusted to T2,7 cases T1 were adjusted to T2,3 cases T2 were adjusted to T1,2 cases T4 were adjusted to T3;1 case was adjusted from N2 to N3,and 1 case was adjusted from N2 to N1.(2)There were statistically significant difference in NPC 2008 N-stage DMFS(χ^(2)=6.430,P=0.040),OS(χ^(2)=6.057,P=0.048)and the 2017 staging N-stage DMFS(χ^(2)=7.121,P=0.028)及OS(χ^(2)=6.623,P=0.036),There was no significant in LRFS with N-stage and the LRFS,DMFS and OS with the T stage and clinical stage between the two stages systems for NPC(P>0.05).Conclusion NPC 2017 revised N stage is more concise and high clinical value for predicting prognosis,but T stage needs to be further simplified.