481例鼻咽癌患者預(yù)后及分期研究
發(fā)布時間：2018-08-13 14:32
【摘要】：第一章481例鼻咽癌患者預(yù)后及分期研究 目的回顧性分析湘雅醫(yī)院481例初診鼻咽癌患者的臨床資料及治療效果、不良反應(yīng),并探索其預(yù)后因素,并對'92福州分期及6th AJCC分期進(jìn)行比較,評價兩種分期的風(fēng)險一致性及差異性。 方法收集從2005年1月到2008年12月在本院接受治療的481例鼻咽癌患者臨床資料,分析其臨床特征及總生存率、無瘤生存率、無局部復(fù)發(fā)生存率及無遠(yuǎn)處轉(zhuǎn)移生存率,按照’92福州分期及6th AJCC分期對所有病例重新進(jìn)行分期,比較兩種分期方式的T分期、N分期、臨床分期及其對預(yù)后的預(yù)測價值。比較兩種分期的風(fēng)險一致性及差異性,進(jìn)行預(yù)后的多因素分析,P0.05為差異有統(tǒng)計學(xué)意義。 結(jié)果1)中位隨訪時間為44個月(10-75個月),4年無局部復(fù)發(fā)率、無遠(yuǎn)處轉(zhuǎn)移率、無瘤生存率及總生存率分別為90.4%、75.0%、68.2%、76.0%。相比與’92福州分期,6th AJCC分期中Ⅱ期病例的比例增高,Ⅲ期、Ⅳ期病例的比例降低。從T分期比較來看,總生存曲線以’92福州分期分開相對較好�！�92福州分期中,T2與T3組、T3與T4組之間差異無統(tǒng)計學(xué)意義,P值分別為0.128和0.473。6th AJCC分期中,T1和T2組、T2與T3組、T3與T4組之間差異無統(tǒng)計學(xué)意義,P值分別為0.053、0.071和0.918�！�92福州分期中,NO與N1組、N2與N3組之間差異無統(tǒng)計學(xué)意義,P值分別為0.931和0.721。6th AJCC分期中,NO與N1組、N2與N3組之間差異無統(tǒng)計學(xué)意義,P值分別為0.645和0.578�！�92福州分期中,Ⅲ期與Ⅳ期曲線之間差異無統(tǒng)計學(xué)意義,P值為0.196。6th AJCC分期中,Ⅲ期與Ⅳ期曲線之間差異無統(tǒng)計學(xué)意義,P值為0.281。2)單因素分析表明年齡、有無頸鞘侵犯、有無顱底侵犯、臨床分期、T分期、N分期、淋巴結(jié)側(cè)數(shù)(單/雙側(cè))為影響總生存率的相關(guān)因素；頸鞘侵犯、顱底侵犯、顱神經(jīng)侵犯、臨床分期、T分期、N分期、淋巴結(jié)側(cè)數(shù)為無瘤生存率的相關(guān)因素；臨床分期、T分期、放療方式、化療方式、有無使用增敏劑為無局部復(fù)發(fā)生存率的相關(guān)因素；性別、頸鞘侵犯、顱底侵犯、分期、T分期、N分期為無轉(zhuǎn)移生存率的相關(guān)因素(兩種分期都有統(tǒng)計學(xué)意義,P0.05)。3)分期因素是影響鼻咽癌最重要的的獨立預(yù)后因素：T分期和N分期對總生存率、無遠(yuǎn)處轉(zhuǎn)移生存率及無瘤生存率的影響有統(tǒng)計學(xué)意義,T分期和放療方式對無局部復(fù)發(fā)率的影響有統(tǒng)計學(xué)意義。是否采用調(diào)強適形放射治療技術(shù)為局部復(fù)發(fā)的獨立預(yù)后因素,調(diào)強適形放射治療組的局部復(fù)發(fā)的風(fēng)險較2D—常規(guī)放射治療組低,有統(tǒng)計學(xué)差異(P=0.018)。結(jié)論T分期和N分期對總生存率、無遠(yuǎn)處轉(zhuǎn)移生存率及無瘤生存率的影響有統(tǒng)計學(xué)意義,T分期和放療方式對無局部復(fù)發(fā)率的影響有統(tǒng)計學(xué)意義。 第二章鼻咽癌調(diào)強適形放療與常規(guī)放療的療效及預(yù)后因素比較 目的放療是治療鼻咽癌的主要手段。本研究對鼻咽癌患者調(diào)強適形放療與常規(guī)放療的療效及預(yù)后因素進(jìn)行比較。 方法收集2005年1月至2008年12月在我院經(jīng)病理活檢確診,無遠(yuǎn)處轉(zhuǎn)移的初治鼻咽癌患者,調(diào)強適形放射治療放療組182例,常規(guī)放射治療放療組198例。進(jìn)行回顧性病例對照研究,比較兩組的臨床資料、療效及預(yù)后因素。 結(jié)果1)調(diào)強適形放射治療組和常規(guī)放射治療組的4年無局部復(fù)發(fā)率、無轉(zhuǎn)移生存率、無瘤生存率、總生存率分別為93.6%和85.3%、79.1%和73.6%、74.7%和65.0%、83.5%和72.1%。調(diào)強適形放射治療組的4年無局部復(fù)發(fā)率及總生存率比常規(guī)放射治療組高,而兩組的無轉(zhuǎn)移生存率及無瘤生存率無統(tǒng)計學(xué)差異。2)調(diào)強適形放射治療組的急性皮膚及口腔粘膜反應(yīng)、急性唾液腺反應(yīng)與常規(guī)放射治療組比較差異有統(tǒng)計學(xué)意義(P0.05),而骨髓抑制反應(yīng)差異無統(tǒng)計學(xué)意義(P0.05)。調(diào)強適形放射治療組發(fā)生各種晚期反應(yīng)的患者比例和嚴(yán)重程度小于常規(guī)放射治療組。3)多因素分析結(jié)果表明,常規(guī)放射治療組臨床分期或T和N分期與鼻咽癌無瘤生存率、無轉(zhuǎn)移生存率及總生存率顯著相關(guān),T分期與鼻咽癌無局部復(fù)發(fā)率顯著相關(guān)。而調(diào)強適形放射治療組T分期、N分期與各生存率無顯著相關(guān)。 結(jié)論調(diào)強適形放射治療治療鼻咽癌相較于常規(guī)放射治療,無局部復(fù)發(fā)率和總生存率提高,不良反應(yīng)減輕。進(jìn)行調(diào)強適形放射治療治療的鼻咽癌患者,T分期不是各生存率的獨立預(yù)后因素。為了減少遠(yuǎn)處轉(zhuǎn)移需采取更有效方法。隨著鼻咽癌治療中調(diào)強適形放射治療應(yīng)用增加,目前的分期系統(tǒng)面臨新的挑戰(zhàn)。
[Abstract]:Chapter one: prognosis and staging of 481 patients with nasopharyngeal carcinoma
Objective To retrospectively analyze the clinical data, therapeutic effect, adverse reactions and prognostic factors of 481 cases of nasopharyngeal carcinoma newly diagnosed in Xiangya Hospital, and to compare the'92 Fuzhou Stage with the 6th AJCC Stage, and to evaluate the risk consistency and difference between the two stages.
Methods The clinical data of 481 patients with nasopharyngeal carcinoma treated in our hospital from January 2005 to December 2008 were collected. The clinical characteristics and overall survival rate, tumor-free survival rate, local recurrence-free survival rate and distant metastasis-free survival rate were analyzed. All patients were re-staged according to'92 Fuzhou Stage and 6th AJCC Stage, and the two stages were compared. Type T staging, N staging, clinical staging and their predictive value for prognosis were compared. Multivariate analysis of prognosis showed that the difference was statistically significant (P 0.05).
Results 1) The median follow-up time was 44 months (10-75 months), 4 years without local recurrence, distant metastasis, tumor-free survival rate and overall survival rate were 90.4%, 75.0%, 68.2%, 76.0%, respectively. Compared with'92 Fuzhou Stage, the proportion of stage II cases in 6th AJCC Stage was higher, and that of stage III and IV cases was lower. There was no significant difference between T2 and T3 groups, T3 and T4 groups in Fuzhou staging, P values were 0.128 and 0.473.6th in AJCC staging, T1 and T2 groups, T2 and T3 groups, T3 and T4 groups, P values were 0.053, 0.071 and 0.918 respectively. There was no significant difference in P values between 0.931 and 0.721.6th AJCC stages. There was no significant difference between NO and N1, N2 and N3, P values were 0.645 and 0.578.'92 in Fuzhou stages. There was no significant difference between stage III and stage IV curves. P values were 0.196.6th AJCC stages, and there was no difference between stage III and stage IV curves. Univariate analysis showed that age, cervical sheath involvement, skull base involvement, clinical stage, T stage, N stage, and the number of lymph nodes (unilateral / bilateral) were the related factors affecting the overall survival rate; cervical sheath involvement, skull base involvement, cranial nerve involvement, clinical stage, T stage, N stage, and lymph node side were the relative factors affecting the overall survival rate. Related factors: clinical stage, T stage, radiotherapy, chemotherapy, sensitizer use or not were the relevant factors for non-local recurrence survival rate; gender, cervical sheath invasion, skull base invasion, stage, T stage, N stage were the most important factors for non-metastatic survival rate (both stages were statistically significant, P 0.05). 3) Staging factors were the most important factors affecting NPC. Independent prognostic factors: T-stage and N-stage had statistically significant effects on overall survival, distant metastasis-free survival and tumor-free survival, T-stage and radiotherapy had statistically significant effects on local recurrence. The risk of local recurrence in the treatment group was lower than that in the 2-D-conventional radiotherapy group (P=0.018). Conclusion T-stage and N-stage have statistically significant effects on the overall survival rate, distant metastasis-free survival rate and tumor-free survival rate, and T-stage and radiotherapy have statistically significant effects on the rate of local recurrence.
The second chapter is the comparison of curative effect and prognostic factors between intensity modulated radiotherapy and conventional radiotherapy for nasopharyngeal carcinoma.
Objective To compare the efficacy and prognostic factors of intensity modulated radiation therapy (IMRT) and conventional radiotherapy (CRT) for nasopharyngeal carcinoma (NPC).
Methods From January 2005 to December 2008, 182 patients with nasopharyngeal carcinoma were treated with intensity modulated radiation therapy (IMRT) and 198 patients with routine radiation therapy (CRT).
Results 1) The 4-year local recurrence rate, metastasis-free survival rate and tumor-free survival rate were 93.6% and 85.3%, 79.1% and 73.6%, 74.7% and 65.0%, 83.5% and 72.1% respectively in IMRT group and conventional radiotherapy group. The 4-year local recurrence-free rate and overall survival rate in IMRT group were higher than those in conventional radiotherapy group. There was no significant difference in metastasis-free survival rate and tumor-free survival rate between the two groups. Multivariate analysis showed that clinical stage or T and N stages were significantly associated with tumor-free survival, metastasis-free survival and overall survival of NPC. T stage was significantly associated with non-local recurrence of NPC. There was no significant correlation between T stage and N stage.
Conclusion Compared with conventional radiotherapy, IMRT has no higher local recurrence rate and overall survival rate, and less adverse reactions. T stage is not an independent prognostic factor for survival in patients with nasopharyngeal carcinoma treated with IMRT. The application of intensity modulated radiation therapy (IMRT) is increasing, and the current staging system is facing new challenges.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2012
【分類號】：R739.63
本文編號：2181268
[Abstract]:Chapter one: prognosis and staging of 481 patients with nasopharyngeal carcinoma
Objective To retrospectively analyze the clinical data, therapeutic effect, adverse reactions and prognostic factors of 481 cases of nasopharyngeal carcinoma newly diagnosed in Xiangya Hospital, and to compare the'92 Fuzhou Stage with the 6th AJCC Stage, and to evaluate the risk consistency and difference between the two stages.
Methods The clinical data of 481 patients with nasopharyngeal carcinoma treated in our hospital from January 2005 to December 2008 were collected. The clinical characteristics and overall survival rate, tumor-free survival rate, local recurrence-free survival rate and distant metastasis-free survival rate were analyzed. All patients were re-staged according to'92 Fuzhou Stage and 6th AJCC Stage, and the two stages were compared. Type T staging, N staging, clinical staging and their predictive value for prognosis were compared. Multivariate analysis of prognosis showed that the difference was statistically significant (P 0.05).
Results 1) The median follow-up time was 44 months (10-75 months), 4 years without local recurrence, distant metastasis, tumor-free survival rate and overall survival rate were 90.4%, 75.0%, 68.2%, 76.0%, respectively. Compared with'92 Fuzhou Stage, the proportion of stage II cases in 6th AJCC Stage was higher, and that of stage III and IV cases was lower. There was no significant difference between T2 and T3 groups, T3 and T4 groups in Fuzhou staging, P values were 0.128 and 0.473.6th in AJCC staging, T1 and T2 groups, T2 and T3 groups, T3 and T4 groups, P values were 0.053, 0.071 and 0.918 respectively. There was no significant difference in P values between 0.931 and 0.721.6th AJCC stages. There was no significant difference between NO and N1, N2 and N3, P values were 0.645 and 0.578.'92 in Fuzhou stages. There was no significant difference between stage III and stage IV curves. P values were 0.196.6th AJCC stages, and there was no difference between stage III and stage IV curves. Univariate analysis showed that age, cervical sheath involvement, skull base involvement, clinical stage, T stage, N stage, and the number of lymph nodes (unilateral / bilateral) were the related factors affecting the overall survival rate; cervical sheath involvement, skull base involvement, cranial nerve involvement, clinical stage, T stage, N stage, and lymph node side were the relative factors affecting the overall survival rate. Related factors: clinical stage, T stage, radiotherapy, chemotherapy, sensitizer use or not were the relevant factors for non-local recurrence survival rate; gender, cervical sheath invasion, skull base invasion, stage, T stage, N stage were the most important factors for non-metastatic survival rate (both stages were statistically significant, P 0.05). 3) Staging factors were the most important factors affecting NPC. Independent prognostic factors: T-stage and N-stage had statistically significant effects on overall survival, distant metastasis-free survival and tumor-free survival, T-stage and radiotherapy had statistically significant effects on local recurrence. The risk of local recurrence in the treatment group was lower than that in the 2-D-conventional radiotherapy group (P=0.018). Conclusion T-stage and N-stage have statistically significant effects on the overall survival rate, distant metastasis-free survival rate and tumor-free survival rate, and T-stage and radiotherapy have statistically significant effects on the rate of local recurrence.
The second chapter is the comparison of curative effect and prognostic factors between intensity modulated radiotherapy and conventional radiotherapy for nasopharyngeal carcinoma.
Objective To compare the efficacy and prognostic factors of intensity modulated radiation therapy (IMRT) and conventional radiotherapy (CRT) for nasopharyngeal carcinoma (NPC).
Methods From January 2005 to December 2008, 182 patients with nasopharyngeal carcinoma were treated with intensity modulated radiation therapy (IMRT) and 198 patients with routine radiation therapy (CRT).
Results 1) The 4-year local recurrence rate, metastasis-free survival rate and tumor-free survival rate were 93.6% and 85.3%, 79.1% and 73.6%, 74.7% and 65.0%, 83.5% and 72.1% respectively in IMRT group and conventional radiotherapy group. The 4-year local recurrence-free rate and overall survival rate in IMRT group were higher than those in conventional radiotherapy group. There was no significant difference in metastasis-free survival rate and tumor-free survival rate between the two groups. Multivariate analysis showed that clinical stage or T and N stages were significantly associated with tumor-free survival, metastasis-free survival and overall survival of NPC. T stage was significantly associated with non-local recurrence of NPC. There was no significant correlation between T stage and N stage.
Conclusion Compared with conventional radiotherapy, IMRT has no higher local recurrence rate and overall survival rate, and less adverse reactions. T stage is not an independent prognostic factor for survival in patients with nasopharyngeal carcinoma treated with IMRT. The application of intensity modulated radiation therapy (IMRT) is increasing, and the current staging system is facing new challenges.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2012
【分類號】：R739.63
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