鼻内镜手术联合化疗与手术联合放疗对高发区早期鼻咽癌患者预后的影响

Effect of endoscopic surgery combined with chemotherapy and radiotherapy on prognosis of early nasopharyngeal carcinoma patients in high incidence area

目的探讨鼻内镜手术联合化疗和内镜手术联合放疗在早期鼻咽癌治疗疗效的差异,为早期鼻咽癌的治疗提供个体化的方案。方法回顾性分析高发区接受手术治疗的68例早期鼻咽癌(T1-2N0M0)患者临床资料,依据治疗方法的不同分为手术+化疗组(34例鼻内镜手术联合化疗)和手术+放疗组(34例鼻内镜手术联合放疗),采用倾向评分匹配法对2组患者资料按照1∶1比例进行匹配,对患者进行随访,比较2组的生存率和血液学毒性。结果手术+化疗组24例和手术+放疗组24例配对成功。匹配后2组患者T分期、临床分期差异均无统计学意义(P>0.05)。手术+化疗组3年的OS和DFS分别为100.0%和95.8%,手术+放疗组3年的OS和DFS分别为100.0%,2组生存率比较差异均无统计学意义(P>0.05)。2组治疗后的骨髓抑制情况比较,差异无统计学意义(P>0.05)。结论内镜手术联合化疗与手术联合放疗治疗早期鼻咽癌临床疗效相当,但无放疗并发症,值得进一步研究。

Objective To investigate the differences in the therapeutic effects of endoscopic surgery combined with chemotherapy and endoscopic surgery combined with radiotherapy in the treatment of early nasopharyngeal carcinoma,and to select individualized treatment strategy for early nasopharyngeal carcinoma.Methods The clinical data of 68 patients with early nasopharyngeal carcinoma(T1-2N0M0)who received surgical treatment in a high-incidence area were retrospectively analyzed.According to different treatment methods,they were divided into the surgery+chemotherapy group(n=34,treated with endoscopic surgery combined with chemotherapy)and the surgery+radiotherapy group(n=34,treated with endoscopic surgery combined with radiotherapy).Propensity score matching was used to match the patient data between the two groups at a 1∶1 ratio.Patients were followed up,and the survival rates and hematological toxicities were compared between the two groups.Results Twenty-four cases in the surgery+chemotherapy group and 24 cases in the surgery+radiotherapy group were successfully matched.After matching,there was no statistically significant difference in T stage,and clinical stage between the two groups(all P>0.05).The 3-year OS and DFS in the surgery+chemotherapy group were 100.0%and 95.8%,respectively,while the 3-year OS and DFS in the surgery+radiotherapy group were 100.0%and 100.0%,respectively,with no significant difference in survival rates between the two groups(both P>0.05).After treatment,there was no statistically significant difference in bone marrow suppression between the surgery+chemotherapy group and the surgery+radiotherapy group(all P>0.05)Conclusion Endoscopic surgery combined with chemotherapy and surgery combined with radiotherapy have comparable clinical efficacy in the treatment of early nasopharyngeal carcinoma,but without radiotherapy-related complications,which is worth further investigation.