局部晚期下咽癌患者诱导化疗联合根治性放疗后复发模式及生存分析

Failure patterns and outcomes after induction chemotherapy followed by radical radiotherapy in patients with locally advanced hypopharyngeal carcinoma

目的回顾分析完成诱导化疗(IC)联合根治性放疗的局部晚期下咽鳞癌(HPSCC)患者的复发模式和生存结果。方法检索2008年8月至2019年12月在北京大学肿瘤医院完成IC联合根治性放疗的局部晚期HPSCC患者,整理相关资料,总结临床特征和复发模式,并行生存分析。结果116例患者符合入组条件,均为鳞癌。中位年龄59岁(39~79岁)。Ⅱ、Ⅲ、Ⅳ_(A)和Ⅳ_(B)期患者分别3、3、60、50例。81例患者接受1~2个周期IC,35例患者接受3~4个周期IC。IC后,分别有54、13和49例患者接受了同步放化疗、放疗联合靶向治疗和单纯放疗。中位随访时间34.6个月(95%CI:28.7~40.5个月),总人群的3年无局部复发生存(LRFS)、无区域复发生存(RRFS)、无远处转移生存(MFS)、无进展生存(PFS)和总生存(OS)分别为63.5%、82.8%、75.2%、47.3%和43.1%。中位PFS和OS时间分别为26.1和28.0个月。59例随访中发现复发/转移,其中22、5、12、10、3、6和1例患者分别发生局部复发、区域复发、远处转移、局部区域复发、区域复发远处转移、局部复发远处转移、局部区域复发远处转移。IC的客观有效率(完全缓解CR+部分缓解PR)为55.2%(64/116)。IC应答(CR+PR)患者的LRFS、RRFS、PFS和OS均优于IC非应答(疾病稳定SD+疾病进展PD)患者(χ^(2)=12.52、5.16、13.19、11.72,P<0.05)。结论IC联合根治性放疗治疗局部晚期HPSCC有一定的疗效,治疗失败以局部区域复发为主。IC应答患者的预后优于IC非应答患者。

Objective To retrospectively analyze the failure patterns and outcomes of patients with locally advanced hypopharyngeal squamous cell carcinoma(HPSCC)after undergoing induction chemotherapy(IC)followed by definitive radiotherapy.Methods For patients with locally advanced HPSCC who were treated with IC and definitive radiotherapy from August 2008 to December 2019,their data were collected from the medical records system,and their clinical characteristics,failure patterns,and survival were retrospectively analyzed.Results A total of 116 eligible patient with squamous cell carcinoma were included in this study.with a median age of 59(39-79),and 3,3,60,and 50 of them had stageⅡ,Ⅲ,Ⅳ_(A),andⅣ_(B) HPSCC,respectively.Among these patients,81 received 1~2 cycles of IC,and 35 received 3-4 cycles of IC.After treatment with IC,54,13,and 49 patients received concurrent chemoradiotherapy,radiotherapy combined with targeted therapy,and radiotherapy alone,respectively.The median follow-up was 34.6 months(95%CI:28.7-40.5 months).The 3-year local recurrence-free survival(LRFS),regional recurrence-free survival(RRFS),metastasis-free survival(MFS),progression-free survival(PFS),and overall survival(OS)of all the patients were 63.5%,82.8%,75.2%,47.3%,and 43.1%,respectively.Median PFS and OS were 26.1 and 28.0 months,respectively.Treatment failure was reported in 59 patients,of whom 22,5,12,10,3,6 and 1 experienced local,regional,distant only,local-regional,regional-distant,local-distant,and local-regional-distant failure,respectively.The objective response rate(CR+PR)of patients after IC was 55.2%(64/116).The LRFS,RRFS,PFS,and OS of IC responders(CR+PR)were better than those of IC non-responders(SD+PD)(χ^(2)=12.52,5.16,13.19,11.72,all P<0.05).Conclusions IC combined with radical radiotherapy has efficacy to a certain extent in the treatment of locally advanced HPSCC,and locoregional recurrence predominates the failure patterns.The prognosis of IC responders is significantly better than that of IC non-responders.