Long-term outcomes of a phase Ⅱ randomized controlled trial comparing intensity-modulated radiotherapy with or without weekly cisplatin for the treatment of locally recurrent nasopharyngeal carcinoma

Background:Salvage treatment for locally recurrent nasopharyngeal carcinoma(NPC) is complicated and relatively limited.Radiotherapy,combined with effective concomitant chemotherapy,may improve clinical treatment outcomes.We conducted a phase Ⅱ randomized controlled trial to evaluate the efficacy of intensity-modulated radiotherapy with concomitant weekly cisplatin on locally recurrent NPC.Methods:Between April 2002 and January 2008,69 patients diagnosed with non-metastatic locally recurrent NPC were randomly assigned to either concomitant chemoradiotherapy group(n = 34) or radiotherapy alone group(n = 35).All patients received intensity-modulated radiotherapy.The radiotherapy dose for both groups was 60 Gy in 27 fractions for 37 days(range 23-53 days).The concomitant chemotherapy schedule was cisplatin 30 mg/m^2 by intravenous infusion weekly during radiotherapy.Results:The median follow-up period of all patients was 35 months(range 2-112 months).Between concomitant chemoradiotherapy and radiotherapy groups,there was only significant difference in the 3-year and 5-year overall survival(OS) rates(68.7%vs.42.2%,P = 0.016 and 41.8%vs.27.5%,P = 0.049,respectively).Subgroup analysis showed that concomitant chemoradiotherapy significantly improved the 5-year OS rate especially for patients in stage rT3-4(33.0%vs.13.2%,P = 0.009),stages Ⅲ-Ⅳ(34.3%vs.13.2%,P = 0.006),recurrence interval >30 months(49.0%vs.20.6%,P = 0.017),and tumor volume >26 cm^3(37.6%vs.0%,P = 0.006).Conclusion:Compared with radiotherapy alone,concomitant chemoradiotherapy can improve OS of the patients with locally recurrent NPC,especially those with advanced T category(rT3-4) and stage(lll-IV) diseases,recurrence intervals >30 months,and tumor volume >26 cm^3.

Impact of primary tumor volume andlocation on the prognosis of patients withlocally recurrent nasopharyngeal carcinoma

Introduction:The properties of a tumor itself were considered the main factors determining the survival of patients with locally recurrent nasopharyngeal carcinoma(NPC)treated with intensity-modulated radiotherapy(IMRT).However,recurrent tumors were mainly evaluated by using the American Joint Committee on Cancer staging system,which was modeled on primary tumors and did not incorporate the tumor volume.This study aimed to investigate the prognostic values of the primary tumor location and tumor volume,and to determine whether evaluating these parameters could improve the current staging system.Methods:Magnetic resonance(MR)images for 229 patients with locally recurrent NPC who underwent IMRT were analyzed retrospectively.Results:The skull base,parapharyngeal space,and intracranial cavity were the most common sites of tumors.There was a difference in the survival between patients with T1 and T2 diseases(77.6%vs.50.0%,P<0.01)and those with T3 and T4 diseases(33.0%vs.18.0%,P=0.04)but no difference between patients with T2 and T3 diseases(50.0%vs.33.0%,P=0.18).Patients with a tumor volume≤38 cm3had a significantly higher survival rate compared with those with a tumor volume>38 cm3(48.7%vs.15.2%,P<0.01).Conclusions:A new staging system has been proposed,with T3 tumors being down-staged to T2 and with the tumor volume being incorporated into the staging,which may lead to an improved evaluation of these tumors.This new system can be used to guide the treatment strategy for different risk groups of recurrent NPC.

Establishment of a prognostic scoring model for regional recurrent nasopharyngeal carcinoma after neck dissection

Objective:The main aim of this study was to establish a scoring model to predict risk of progression and survival in patients with regionally recurrent nasopharyngeal carcinoma(NPC).Methods:Three hundred and forty-eight patients subjected to neck dissection from 2003 to 2017 were included for study.Clinicopathologic information for each patient was analyzed.Independent prognostic factors were selected using the Cox proportional hazards model and incorporated into the scoring model.Concordance index(C-index)and calibration curves were used to verify discrimination and calibration,respectively and the results validated using bootstrap resampling.Results:Microscopic positive lymph node>2[hazard ratio(HR),2.19;95%confidence interval(CI),1.30–3.68;P=0.003],extranodal extension(HR,2.75;95%CI,1.69–4.47;P<0.001),and lower neck involvement(HR,1.78;95%CI,1.04–3.04;P=0.034)were identified from multivariate analysis as independent factors for overall survival(OS).A qualitative 4-point scale was generated to stratify patients into 4 risk groups for predicting OS and progression-free survival(PFS).The novel scoring model demonstrated enhanced discrimination(C-index=0.69;95%CI,0.62–0.76)relative to the original recurrent tumor-node-metastasis(rTNM)staging system(C-index=0.56;95%CI,0.50–0.62),and was internally validated with a bootstrap-adjusted C-index of 0.70.The calibration curve showed good agreement between predicted probabilities and actual observations.Conclusions:The scoring system established in this study based on a large regionally recurrent NPC cohort fills a gap regarding assessment of risk and prediction of survival outcomes after neck dissection in this population and could be further applied to identify high-risk patients who may benefit from more aggressive intervention.

Prognostic value of plasma Epstein-Barr virus DNA level during posttreatment follow-up in the patients with nasopharyngeal carcinoma having undergone intensity-modulated radiotherapy

Background: The value of Epstein-Barr virus(EBV) DNA assay during posttreatment follow-up of the patients with nasopharyngeal carcinoma(NPC) presenting with different pretreatment plasma EBV DNA levels remains unclear. In the present study, we aimed to evaluate the prognostic value of plasma EBV DNA assay during posttreatment followup in the patients with NPC who have undergone intensity-modulated radiotherapy.Methods: The medical records of 385 NPC patients treated with intensity-modulated radiotherapy between November 2009 and February 2012 were reviewed. All patients underwent plasma EBV DNA assays before treatment, within3 months after treatment, and then every 3-12 months during posttreatment follow-up period. The recurrence rates for patients with different pretreatment and posttreatment follow-up plasma EBV DNA levels were analyzed.Results: Of the 385 patients, 267(69.4%) had detectable pretreatment plasma EBV DNA(> 0 copy/mL) and 93(24.2%) had detectable posttreatment EBV DNA during a median follow-up of 52.8 months(range 9.3-73.8 months).Detectable EBV DNA during posttreatment follow-up was found in 14.4%(17/118) and 28.5%(76/267) of patients with undetectable and detectable pretreatment EBV DNA, respectively, and was significantly associated with tumor recurrence in both patient groups. EBV DNA was detectable in 12.8%(40/313) of patients who remained disease-free,56.4%(22/39) of patients with locoregional recurrence alone, and 93.9%(31/33) of patients with distant metastasis as the first recurrence event(P < 0.001); 6.5%(19/292) of patients with undetectable EBV DNA and 57.0%(53/93) of patient with detectable EBV DNA during posttreatment follow-up experienced tumor recurrence. Compared with other cut-off values, the cut-off value of 0 copy/mL for EBV DNA during posttreatment follow-up had the highest area under the ROC curve(AUC) value(0.804,95% confidence interval 0.741-0.868) for predicting tumor recurrence(sensitivity, specificity, and accuracy: 73.6%, 87.2%, and 84.7%, respectively).Conclusion: Plasma EBV DNA level during posttreatment follow-up is a good marker for predicting distant metastasis but not locoregional recurrence in the patients with NPC irrespective of the pretreatment EBV DNA levels.

Stereotactic radiotherapy for the treatment of nasopharyngeal carcinoma: a Meta-analysis of 1371 cases in China

Objective The aim of this study was to clarify the outcomes of stereotactic radiotherapy for the treatment of local residual and(or) local recurrent nasopharyngeal carcinoma and to promote scientific clinical treatment and research on it in China and other countries by creating a large data resource.Methods This Meta-analysis conducted a literature search using the China National Knowledge Infrastructure database for all clinical research articles on stereotactic radiotherapy for the treatment of local residual and(or) local recurrent nasopharyngeal carcinoma in China.Data on patient cohort numbers and other research factors were recorded for every relevant clinical research article.Calculated and analyzed these fact sheets to pave the way for the objective of this project.Results A total of 40 clinical research articles including 1,371 patients in China from 1998 to 2012 were identified.The average cohort size was 34 patients(range 9-98 patients).The average total radiation dose range was 16-33.6 Gy.The average study or treatment duration was 3.51 years.The calculated average follow-up time was 31.59 months.Conclusion The study provided the largest resource for further research and Meta-analyses to determine the clinical pathway of stereotactic radiotherapy for the treatment of local residual and(or) local recurrent nasopharyngeal carcinoma.The results indicated that variability in the total radiation dose,treatment or research time,and follow-up duration may have contributed to the complications and side effects of stereotactic radiotherapy for local residual and(or) local recurrent nasopharyngeal carcinoma in China.The calculated average total radiation dose,follow-up time,and treatment and research durations may be referenced for future treatment and research.This study also proposed worldwide cooperation for the metaanalysis of research articles on stereotactic radiotherapy for treating local residual and(or) local recurrent nasopharyngeal carcinoma.

Surveillance tools for detection of recurrent nasopharyngeal carcinoma: An evidence-based review and recommendations

Objective: Nasopharyngeal carcinomas (NPC) are tumors arising from epithelium of the nasopharynx. The 5-year survival rate of primary NPC is 80% with significant risks of recurrence. The objective here is to provide an evidence-based systemic review of the diagnostic value of different modalities in detecting local, regional, and distal recurrent NPC, as well as the associated costs with these modalities.Methods: MEDLINE, EMBASE, and the Cochrane review database were queried. Two hundred and twenty-three abstracts were generated using the inclusion criteria: patients >18 years of age;histopathological reference standard;and modalities pertaining to imaging or microbiology.Results: Twenty-four manuscripts fulfilled the inclusion criteria and 5 surveillance tools identified: endoscopy, MR, FDG-PET, Tc-99m MIBI and201TI SPECT, and EBV DNA.Conclusions: For local surveillance, endoscopy is the gold standard recommendation, with increased efficacy if Narrow Band Imaging or contact endoscopy are utilized. MRI and FDG-PET is also recommended to help with local to distal spread;however, Tc-99m MIBI and201TI SPECT are options as well. EBV DNA is recommended as a cheap and accessible adjunct surveillance tool if an available as an option.

颈部影像报告和数据系统在MRI诊断早期单纯黏膜型鼻咽癌局部复发中的应用

目的探讨颈部影像报告和数据系统(neck imaging reporting and data systems,NI-RADS)MRI对单纯黏膜型鼻咽癌局部复发(exclusive mucosal local recurrent nasopharyngeal carcinoma,EMLRNPC)与黏膜治疗后改变(mucosal posttreatment changes,MPTC)的诊断价值,尝试为NI-RADS MRI词典中的局灶性黏膜异常建议附加定性扩散加权成像(diffusion-weighted imaging,DWI)标准。材料与方法回顾性分析2015年2月至2023年2月经病理或影像随访确诊的21例EMLRNPC和29例MPTC。先由2名影像医师独立评价MRI表现,进行NI-RADS MRI分类,再进行附加定性DWI标准的改良NI-RADS MRI分类,3个月后,由其中的1名高年资影像医师再次进行分类。采用Cohen’s Kappa检验评估观察者间、观察者内NI-RADS分类一致性。绘制受试者工作特征(receiver operating characteristic,ROC)曲线评价这两种NI-RADS分类对EMLRNPC与MPTC的诊断效能,曲线下面积(area under the curve,AUC)的比较采用DeLong检验。结果NI-RADS MRI、改良NI-RADS MRI的分类观察者间与观察者内一致性为0.69与0.88、0.83与0.96。NI-RADS MRI和改良NI-RADS MRI鉴别诊断ELRNPC与MPTC的AUC、敏感度、特异度为0.845[95%置信区间(confidence interval,CI):0.715~0.932]、100.0%(95%CI:83.9%~100.0%)、69.0%(95%CI:49.2%~84.7%)和0.966(95%CI:0.871~0.997)、100.0%(95%CI:83.9%~100.0%)、93.1%(95%CI:77.2%~99.2%),两种分类的AUC间差异有统计学意义(Z=2.985,P=0.003)。结论NI-RADS MRI与附加定性DWI标准的改良NI-RADS MRI对EMLRNPC与MPTC均具有较高的鉴别诊断价值,改良NI-RADS MRI分类的诊断效能、一致性更高。

血浆EBV-DNA联合窄带成像技术在鼻咽癌复发监测中的应用价值

目的探讨血浆EB病毒DNA(EBV-DNA)联合窄带成像技术(NBI)在鼻咽癌(NPC)复发监测中的应用价值。方法选取NPC复发患者86例和未复发患者142例为研究对象,观察EBVDNA、NBI、EBV-DNA联合NBI方法在NPC复发诊断中的灵敏度、特异度、阳性预测值、阴性预测值、一致性检验(Kappa值);采用受试者工作特征曲线(ROC)分析EBV-DNA、NBI、EBV-DNA联合NBI诊断NPC复发的曲线下面积(AUC)。结果ROC分析结果显示,EBV-DNA、NBI、EBV-DNA联合NBI诊断NPC复发的AUC分别为0.826、0.845、0.893,EBV-DNA联合NBI预测复发的AUC比单一方法检测大,差异具有统计学意义(P<0.05)。分层分析结果显示,预测早期患者NPC复发和晚期NPC复发的AUC为0.924和0.865,Kappa值为0.827和0.696。结论在监测NPC复发诊断中,EBV-DNA联合NBI方法比单一方法效能高,在临床分期为早期的NPC患者中效果更佳,值得临床上应用推广。

复发性鼻咽癌患者鼻内镜手术围术期输血的危险因素及预测模型的建立

目的 筛选复发性鼻咽癌患者鼻内镜手术围术期输血的危险因素,建立列线图预测模型。方法 回顾性分析2021年1月至2023年5月行鼻内镜手术的262例复发性鼻咽癌患者的临床资料,根据围术期是否输血分为两组:未输血组和输血组。通过单因素和多因素Logistic回归分析筛选围术期输血的危险因素,构建列线图预测模型,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)。结果 有46例(17.6%)患者在鼻内镜手术围术期输血。多因素Logistic回归分析显示,术前Hb浓度70~<100 g/L(OR=6.178,95%CI 2.271~16.805,P<0.001)、术前白蛋白浓度25~<35 g/L(OR=2.126,95%CI 1.021~4.424,P=0.044)、手术分型Ⅲ或Ⅳ型(OR=4.725,95%CI 1.634~13.584,P=0.004)是复发性鼻咽癌患者鼻内镜手术围术期输血的独立危险因素。列线图模型的AUC为0.769(95%CI 0.701~0.838),敏感性为67.6%,特异性为76.1%。结论 复发性鼻咽癌患者鼻内镜手术围术期输血的独立危险因素是术前Hb浓度70~<100 g/L、术前白蛋白浓度25~<35 g/L、手术分型Ⅲ或Ⅳ型,基于以上危险因素建立的列线图模型对围术期输血有良好的预测能力。

鼻咽癌患者18F-FDG PET/CT代谢参数与临床病理特征的关系及对局部复发的预测价值

目的探讨18F-脱氧葡萄糖(FDG)正电子发射计算机断层扫描(PET/CT)代谢参数与鼻咽癌患者临床病理特征的关系及其对局部复发的预测价值,为临床诊治提供可靠依据。方法选取2020年1月~2022年1月于中山大学肿瘤防治中心行放疗的200例鼻咽癌患者作为研究对象,根据治疗后6个月内复发情况分为复发组(n=85)、未复发组(n=115)。比较两组临床病理特征及18F-FDG PET/CT代谢参数。分析不同参数与临床病理特征的关系及其对局部复发的预测价值。分析各参数不同表达者局部复发的危险度。结果复发组临床分期Ⅰ~Ⅱ期比例低于未复发组,淋巴结转移比例及18F-FDG PET/CT代谢参数最大标准摄取值(SUVmax)、平均标准摄取值(SUVmean)、峰值标准摄取值(SUVpeak)、病灶糖酵解总量(TLG)、肿瘤代谢体积(MTV)高于未复发组(P<0.05);SUVmax、MTV、TLG与临床分期、淋巴结转移呈正相关(P<0.05);SUVmax、SUVpeak、SUVmean、MTV、TLG联合预测局部复发的AUC高于单项预测(P<0.05);各参数高水平者局部复发风险分别是低水平的2.406倍、3.189倍、2.374倍、3.102倍、4.170倍。结论18F-FDG PET/CT代谢参数SUVmax、MTV、TLG与鼻咽癌患者临床病理特征具有相关性,其与SUVpeak、SUVmean联合预测局部复发具有一定预测价值。

特瑞普利单抗联合阿帕替尼二线治疗复发/转移性鼻咽癌的疗效及安全性

目的:探讨特瑞普利单抗联合阿帕替尼二线治疗复发/转移性鼻咽癌(RM-NPC)的疗效及安全性,并分析影响预后的因素。方法:选取2020年03月至2022年03月一线铂类治疗失败的37例RM-NPC患者,予以特瑞普利单抗3 mg/kg,每2周静脉滴注,阿帕替尼250 mg,日1次口服。观察其有效性和安全性,采用Kaplan-Meier法分析无进展生存期(PFS)和总生存期(OS),采用COX比例风险回归模型分析影响预后的因素。结果:37例RM-NPC患者中位治疗时间为8个周期(3~32个周期),客观缓解率67.6%,疾病控制率86.5%,中位缓解持续时间12.4个月(95%CI:10.1~14.7个月),中位PFS 11.6个月(95%CI:9.9~13.4个月),1年无进展生存率42.0%,1年总生存率82.9%。多因素分析显示初诊转移和EBV-DNA滴度≥10 000 IU/mL是影响患者预后的独立因素。不良反应大部分≤Ⅱ级,Ⅲ级以上不良反应主要为高血压、鼻咽部坏死、转氨酶升高和手足综合征。结论:特瑞普利单抗联合阿帕替尼显著提高一线铂类治疗失败RM-NPC患者的临床疗效,改善患者生存预后,且安全性可控,可作为RM-NPC患者二线治疗的一种选择。

颈内动脉颅底段的CT测量及三维重建

目的经鼻内镜鼻咽切除术是目前鼻咽颅底病变微创手术的首选,但颈内动脉损伤是该手术的潜在危险。通过术前对患者CT资料进行多层面观测和图像三维重建,评估颈内动脉的走行及其与相关结构的空间关系,以便指导鼻内镜鼻咽及咽旁隙颅底手术。方法选择40例(80侧)鼻咽及其周围颅底无病变表现的头部增强CT资料,在图像工作站上对不同层面中颈内动脉与周围骨性结构的关系进行测量,对图像进行三维重建观察颈内动脉与周围结构的空间关系。结果在骨性下鼻甲层面中,骨性下鼻甲后缘、翼内板后缘、翼外板后缘、中线与颈内动脉的距离分别为(38.8±4.0)、(25.9±2.8)、(19.7±3.8)、(23.8±2.7)mm;骨性下鼻甲后缘及翼内板后缘的延长线与颈内动脉的夹角为(15.0±4.0)、(17.0±6.0)°。在后鼻孔下缘层面中,翼内板后缘与颈内动脉的距离和角度分别为(27.2±3.5)mm和(12.0±4.0)°。三维重建获得清晰的立体图像。颈内动脉颈段的走行40%发生变异,其中大部分为弯曲型,位于口咽至咽隐窝水平,突向咽后壁。结论患者术前进行个体化CT三维重建能为经鼻内镜鼻咽颅底手术提供关键解剖信息,便于术中定位颈内动脉,提高手术安全性。人群中颈内动脉变异率较高,突向咽后壁,经鼻内镜鼻咽-咽旁颅底手术风险增高,术前应充分评估。

复发鼻咽癌的治疗:挑战与希望并存

尽管随着以调强放疗为主的综合治疗的广泛开展,鼻咽癌的复发率较传统二维放疗时代已经明显降低,但仍有相当一部分患者会在根治性放疗后出现复发。复发鼻咽癌(rNPC)患者的总体预后欠佳,治疗上依然面临着巨大挑战。近年来,随着新技术、新药物和新理念的发展,rNPC治疗的效果和安全性正在逐步提升,为rNPC患者带来了新的希望。为此,本文将就rNPC的治疗现状和最新进展进行归纳、梳理和分析,以期为rNPC临床治疗决策提供更多参考。

血清叉头框D1在鼻咽癌患者中的表达及其与放疗后复发转移关系研究

目的:探讨血清叉头框D1(FOXD1)在鼻咽癌(NPC)患者中的表达及其与放疗后复发转移的关系。方法:选取本院NPC患者235例为NPC组,另选取同期本院体检健康志愿者246例为对照组。比较两组一般资料及血清FOXD1水平。分析血清FOXD1表达与NPC患者临床病理特征的关系。对化疗后NPC患者随访3年,记录复发转移情况。采用Cox回归分析NPC患者放疗后复发转移的影响因素。采用Spearman法分析血清FOXD1水平与肿瘤分化程度及EB病毒感染的相关性。绘制受试者工作特征(ROC)曲线分析血清FOXD1对NPC患者放疗后复发转移的预测价值。结果:NPC组FOXD1水平高于对照组(P<0.05)。NPC患者血清FOXD1表达与肿瘤分化程度、TNM分期、颈部淋巴结转移、肿瘤浸润深度、颅底侵犯、EB病毒感染有关(均P<0.05)。肿瘤低分化、EB病毒感染阳性及FOXD1高表达是NPC患者放疗后复发转移的独立危险因素(均P<0.05)。血清FOXD1水平与肿瘤分化程度呈负相关,与EB病毒感染呈正相关(均P<0.05)。FOXD1对NPC患者放疗后复发转移具有一定的预测价值(P<0.05)。结论:FOXD1在NPC患者血清中表达水平升高,与临床病理特征有关,是患者放疗后复发转移的危险因素,对放疗后复发转移具有一定的预测价值。

带血管蒂鼻中隔黏膜瓣在T1、T2期复发性鼻咽癌术后修复中的应用

目的 探讨带血管蒂鼻中隔黏膜瓣(HBF)在T1、T2期复发性鼻咽癌鼻内镜手术中的应用及疗效。方法 回顾性分析2019年7月至2022年3月于南京鼓楼医院耳鼻咽喉头颈外科进行鼻内镜下鼻咽部肿瘤切除术的10例T1、T2期复发性鼻咽癌患者。其中8例行HBF修复,1例行阔筋膜修复,1例未行修复。所有患者均经鼻内镜下手术,切除肿瘤后运用HBF或阔筋膜瓣修复创面。分析其疗效及并发症。结果 所有患者均经鼻内镜完成手术并实现肿瘤完整切除。8例行HBF修复者黏膜瓣成活,鼻咽部愈合理想,无创面感染坏死,无干痂,无嗅觉减退,发生鼻中隔小穿孔1例。所有患者无瘤生存。8例HBF患者术后NRS、SNOT-22评分较术前下降。结论 HBF可有效修复鼻咽部肿瘤术后创面,保护颅底重要结构并减少了并发症。

老年鼻咽癌癌组织中Kruppel样因子5及Kruppel样因子9表达与患者复发的相关性

目的探讨老年鼻咽癌癌组织中Kruppel样因子5(KLF5)、Kruppel样因子9(KLF9)表达与患者复发间的关系。方法回顾性分析2016年5月至2018年5月湖南省脑科医院收治的263例老年鼻咽癌患者的临床资料,患者治疗后均行5年院外随访,观察患者是否出现复发。通过Western blotting技术检测老年鼻咽癌患者癌组织中KLF5、KLF9相对蛋白表达量,比较复发患者与非复发患者的基础资料信息[性别、年龄、国际抗癌联盟(UICC)分期、病理类型、疗程延长时间、放疗剂量、是否放疗联合化疗、是否鼻腔受侵、是否口咽受侵、是否颅底骨质受侵、是否颅内受损、是否颅神经损伤]及KLF5、KLF9差异。通过多因素logistic逐步回归分析老年鼻咽癌患者复发的危险因素。采用SPSS 22.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ^(2)检验。结果263例老年鼻咽癌患者治疗结束后行5年院外随访,复发患者共27例(10.27%)。与非复发组患者相比,复发组患者UICC分期Ⅲ~Ⅳ期、未行放疗联合化疗、颅底骨质受侵、颅神经损伤占比较高,差异有统计学意义(均P<0.05)。与非复发组患者相比,复发组患者KLF5、KLF9相对蛋白表达量下降,差异有统计学意义(P<0.05)。对KLF5、KLF9进行受试者工作特征(ROC)曲线分析,其对老年鼻咽癌患者复发有较好的预测价值,且联合预测价值更高,曲线下面积分别为0.800、0.790、0.894,且均有P<0.05。多因素logistic回归分析显示,UICC分期Ⅲ~Ⅳ期(OR=3.420,95%CI 1.715~6.820)、未行放疗联合化疗(OR=1.434,95%CI 1.106~1.859)、颅底骨质受侵(OR=2.790,95%CI 1.337~5.822)、颅神经损伤(OR=1.249,95%CI 1.026~1.520)、KLF5<2.495(OR=4.453,95%CI 1.469~13.498)、KLF9<0.305(OR=2.719,95%CI 1.604~4.609)是老年鼻咽癌患者复发的危险因素。结论老年鼻咽癌患者癌组织内KLF5、KLF9表达下降,且KLF5、KLF9表达为患者复发的影响因素。

110例次不同主要诊断鼻咽癌住院患者检验危急值回顾性分析

目的分析总结鼻咽癌住院患者常见检验危急值的种类及分布情况,探讨不同主要诊断危急值项目具体分布及特点,并探讨晚期鼻咽癌患者危急值临床安全管理对策。方法采用回顾性队列分析,收集2021年1月至2023年12月广东省人民医院耳鼻喉科病房78例鼻咽癌住院患者110例次危急值资料。统计各项危急值发生率及频次,并根据出院主要诊断分为放射性骨坏死、鼻咽恶性肿瘤(复发)、鼻出血及其他3组。使用SPSS 22.0软件进行Fisher检验分析各组危急值发生情况及具体分布,以P<0.05为差异有统计学意义。结果鼻咽癌住院患者检验危急值分布中多重耐药菌感染38.18%、电解质异常29.09%、血常规异常17.27%,凝血功能异常8.18%;主要诊断为放射性骨坏死患者和鼻咽恶性肿瘤(复发)患者的多重耐药菌感染、电解质异常、血常规异常发生率差异有统计学意义(P<0.05)。16例患者在同次住院期间发生2项及以上危急值项目,7例患者在两次住院期间出现相同项目危急值。结论鼻咽癌住院患者的危急值中包括耐药菌感染、电解质异常、血常规异常、凝血功能异常。不同主要诊断鼻咽癌患者危急值项目分布差异有统计学意义。同一患者同时出现多项危急值提示病情严重,应及时处理。放射性骨坏死患者多次住院易反复出现多重耐药菌感染,鼻咽恶性肿瘤复发患者应关注上次化疗期间出现的危急值项目。

鼻咽癌放疗后鼻咽颅底坏死与肿瘤复发鉴别的研究

目的本研究通过对鼻咽癌(NPC)放疗后鼻咽颅底坏死及肿瘤复发患者的基本信息、症状、内镜及影像学等进行对比,探讨两者差异性,为患者的诊断提供依据,利于临床评估和制定精准的治疗方案。方法以2012年1月-2022年4月38例NPC放疗后鼻咽颅底破坏患者为研究对象,根据病理结果分为坏死组和复发组,对比两组性别构成、发病年龄、二次放疗、发病时间、鼻内镜检查表现、CT及MRI影像表现的差异。结果两组在性别构成、发病时间、二次放疗、鼻腔恶臭、内镜下鼻咽坏死情况及新生物情况、CT骨质破坏表现、鼻咽软组织强化后表现、MRI中软组织及骨髓T2及强化表现上存在显著差异(P<0.05)。结论通过对NPC放疗后鼻咽颅底破坏患者的性别、发病时间、临床症状、鼻内镜表现、CT、MRI表现进行综合分析,能够对NPC放疗后鼻咽颅底坏死与肿瘤复发进行初步鉴别,有助于临床上制定精准的治疗方案。

基于围术期数据探究鼻咽癌内镜术后复发及生存状况

目的:探讨基于围术期数据探究鼻咽癌内镜术后复发及生存状况。方法:选取2017年1月—2019年12月我院收治的90例鼻咽癌患者作为研究对象,均成功实施鼻内镜鼻咽切除手术。术后3年,记录复发情况及围术期资料,采用COX模型分析鼻咽癌内镜术后复发影响因素,绘制受试者工作特征(ROC)曲线及卡普兰—迈耶(K-M)曲线。结果:(1)术后3年,鼻咽癌内镜术后复发率为23.53%。(2)COX模型多因素分析显示,EBV DNA载量、血清VEGF≥800ng/L、MMP-3≥30μg/L是鼻咽癌内镜术后复发高危因素,Fn≥100ng/L是鼻咽癌内镜术后复发保护因素(P<0.05)。(3)ROC曲线,结果显示VEGF、MMP-3、Fn、EBV DNA载量及联合预测鼻咽癌术后复发的AUC分别为0.837、0.821、0.829、0.836、0.911。(4)EBV DNA载量亚组、VEGF亚组、MMP-3亚组、Fn亚组生存率比较,差异有统计学意义(P<0.001)。结论:鼻咽癌内镜术后复发影响因素为EBV DNA载量及血清VEGF、MMP-3、Fn水平,监测其水平变化有助于预测术后复发,了解生存状况,为本病确定合理治疗提供依据。

免疫治疗在局部晚期鼻咽癌中的研究进展

鼻咽癌起病隐匿,恶性度高,超过70%的患者在初诊时即为中晚期阶段,目前新辅助化疗联合同步放化疗(CCRT)作为局部晚期鼻咽癌(LA-NPC)的标准治疗手段,虽然具有较好的疾病缓解率,但对一些患者远处转移风险仍然存在。随着免疫治疗的快速发展,基于程序性死亡-1/程序性死亡配体-1(PD-1/PD-L1)阻断的免疫检查点抑制剂(ICIs)在中国取得突破性进展,PD-1抑制剂联合化疗已作为复发或转移性鼻咽癌(R/M NPC)的一线治疗药物,同时免疫治疗在LA-NPC的治疗中取得新突破,许多前瞻性临床研究正在进行中。在本综述中,根据已发表的临床数据和正在进行的试验,全面概述LA-NPC免疫治疗的基本原理和重要研究成果,以期为临床实践和未来的临床研究提供见解。