诱导化疗后的Ⅲ-IVA期鼻咽癌患者同期化疗最适奈达铂总量的研究

Optimal Total Nedaplatin Dose of Concurrent Chemotherapy in Patients with StageⅢ-IVA Nasopharyngeal Carcinoma

目的探索诱导化疗后的Ⅲ-IVA期的鼻咽癌患者放疗同期化疗时最适累积奈达铂总量,分析同期奈达铂总量对诱导化疗后的鼻咽癌患者的预后影响。方法收集2013年1月至2018年12月首诊于云南省肿瘤医院共109例接受IC+奈达铂CCRT,根据CND四分位数将奈达铂组患者分为低(≤120 mg/m^(2))、中(121-200 mg/m^(2))、高剂量(>200 mg/m^(2))3个组别,再根据肿瘤诱导化疗后反应将奈达铂组患者分别分为CR/PR和SD/PD 2个亚组,分析统计诱导化疗后不同累积奈达铂总量对患者的预后的影响,以期得到最适CND。结果CND低、中、高剂量组各项生存率,差异均无统计学意义(P>0.05);根据CR/PR、SD/PD分组进行生存分析,累积OS率分别为77.2%、50.0%,3 a OS率98.2%、62.9%,累积PFS率63.2%、45.0%,3 a PFS率77.2%、54.8%,CR/PR组的各生存率优于SD/PD组(P<0.05);根据CND低、中、高剂量分别对2个亚组进行分析,CR/PR亚组的累积OS率为93.3%、93.8%、60.0%(P=0.046),3 a OS率100.0%、93.8%、100.0%(P>0.05),累积PFS率86.7%、78.1%、30.0%(P=0.007),3 a PFS率93.3%、90.6%、60.0%(P=0.017),低剂量组及中剂量组在OS率、PFS率、3 a PFS率方面较高剂量组显示出显著优势;SD/PD亚组中各生存率,差异无统计学意义(P>0.05);在多因素分析中,IC后的疗效评价(CR/PR&SD/PD)是Ⅲ-IVA期鼻咽癌患者OS、3 a OS、PFS、3 a PFS的独立预后因素(P<0.05)。结论Ⅲ-IVA期鼻咽癌患者IC后CR/PR患者的生存获益远优于SD/PD的患者,IC后的肿瘤反应(CR/PR&SD/PD)是Ⅲ-IVA期鼻咽癌患者的独立预后因素。Ⅲ-IVA期鼻咽癌患者在IC后CR/PR的亚组中,接受低、中CND的患者生存率较高剂量组改善显著,对于该类患者来说CND似乎不需要超过200 mg/m^(2)即可获得较好生存结果。

Objective To explore the most appropriate total cumulative nedaplatin dose during chemotherapy for patients at theⅢ-IVA stage after induced chemotherapy,and to analyze the effect of the total amount of nedaplatin on the prognosis of nasopharyngeal carcinoma patients after induction chemotherapy.Methods In this study,a total of 109 patients who were first diagnosed at Yunnan Cancer Hospital from 2013 to2018 received induction chemotherapy(IC)plus concurrent chemoradiotherapy(CCRT).According to the CND quartile,the patients were divided into three groups:low(≤120 mg/m^(2)),medium(121-200 mg/m^(2))and high dose(>200 mg/m^(2)).According to the response after tumor induction chemotherapy,the Nedaplatin group was divided into CR/PR and SD/PD subgroups,respectively.The effects of different cumulative dose of nedaplatin on the prognosis of patients after induction chemotherapy were analyzed to obtain the optimal CND.Results The difference in survival rates between the low,medium and high dose groups of CND were not statistically significant(P>0.05).According to the survival analysis of CR/PR and SD/PD groups,the cumulative OS rates were 77.2%and 50.0%,the 3-year OS rates were 98.2%and 62.9%,the cumulative PFS rates were 63.2%and 45.0%,and the 3 a PFS rates were 77.2%and 54.8%,respectively.The survival rate of CR/PR group was better than that of SD/PD group(P<0.05).According to the low,medium and high dose of CND,the two subgroups were analyzed respectively.The cumulative OS rate of CR/PR subgroup was 93.3%,93.8%and 60.0%(P=0.046),and the 3year OS rates were 100.0%,93.8%and 100.0%(P>0.05).The cumulative PFS rates were 86.7%,78.1%and30.0%(P=0.007),and the 3 year PFS rates were 93.3%,90.6%and 60.0%(P=0.017).The low-dose and medium-dose groups showed significant advantages in OS rate,PFS rate and 3year PFS rate.There was no significant difference in survival rate among SD/PD subgroups(P>0.05).In multivariate analysis,efficacy evaluation after IC(CR/PR&SD/PD)was an independent prognostic factor for OS,3 year OS,PFS,and 3 year PFS in patients with stageⅢ-IVA nasopharyngeal carcinoma(P<0.05).Conclusion The survival benefit of CR/PR patients with stageⅢ-IVA nasopharyngeal carcinoma after IC is much better than that of SD/PD patients.Tumor response after IC(CR/PR&SD/PD)is an independent prognostic factor for stageⅢ-IVA nasopharyngeal carcinoma patients.In the post-IC CR/PR subgroup of patients with stageⅢ-IVA nasopharyngeal carcinoma,the survival rate of patients receiving low and medium CND improved significantly in the higher dose group.It seems that CND does not need to exceed 200 mg/m^(2)to achieve better survival results for these patients.