發(fā)布時間：2018-06-29 09:27

  本文選題：鼻咽腫瘤 + 分期�。� 參考：《蘇州大學》2011年碩士論文

【摘要】：目的目前國際上尚未應用統(tǒng)一的鼻咽癌臨床分期,我國在1992分期的基礎上于2008年制定了2008分期標準,而國際抗癌聯(lián)盟(UICC)也于2010年發(fā)布了最新的第七版鼻咽癌分期標準。但是,現(xiàn)在非常缺乏分期標準相互之間優(yōu)劣性的比較,不利于相互之間指導治療、評估療效和學術交流。我們通過對347例鼻咽癌患者的回顧性分析,比較鼻咽癌中國1992、2008和UICC 2010分期標準之間的一致性,評價它們在預測鼻咽癌放療療效中的價值。 方法回顧性分析347例無遠處轉移的初治鼻咽癌患者的臨床資料,對每例患者分別用中國1992、2008和UICC 2010分期標準進行T、N和臨床分期。采用Kappa法分析不同分期標準之間各期病例數(shù)分布的一致性,采用Kaplan-Meier法分別評估三種分期標準的臨床分期、T分期和N分期對總生存率、局部無復發(fā)生存率和無遠處轉移生存率的影響,Log-rank檢驗其差異性。 結果中國2008分期和UICC 2010分期標準之間的臨床分期、T和N分期的病例構成比例的一致性均優(yōu)于它們各自與1992分期之間的比較,Kappa值分別為0.700、0.881、0.722;2008分期和UICC2010分期標準分別與1992分期標準在臨床分期、T分期、N分期病例構成比的比較中T分期一致性較好,Kappa值分別為0.570和0.548、0.877和0.761、0.485和0.531。2008分期和UICC 2010分期標準下各臨床分期的總生存曲線走勢均優(yōu)于1992分期(χ~2=36.30, P=0.000;χ~2=37.73, P=0.000;χ~2=33.19, P=0.000);1992分期中Ⅲ期和Ⅳ期的總生存曲線相互交錯(χ~2=0.401,P=0.526);三種分期標準的T1與T2、T2與T3、T3和T4期之間的局部無復發(fā)生存率均無統(tǒng)計學差異(χ~2=0.529、0.502、1.849,P=0.467、0.479、0.174和χ~2=2.096、1.986、1.248,P=0.148、0.159、0.264及χ~2=0.595、0.873、0.768,P=0.441、0.350、0.381);1992分期標準中N_0與N_1、N_1與N_2、N_2與N_3之間均無統(tǒng)計學差異(χ~2=3.712、3.113、2.014,P=0.054、0.078、0.156),2008分期標準中N_1與N_2,N_2與N_3之間有統(tǒng)計學意義(χ~2=10.488、5.059,P=0.001、0.024);UICC 2010分期標準中僅N_1與N_2之間有統(tǒng)計學差異(χ~2=7.731,P=0.0054)。 結論中國2008分期和UICC2010分期標準的病例構成比例的一致性優(yōu)于它們各自與1992分期之間的比較結果。三種分期標準均能提示鼻咽癌患者的放療療效,但中國2008分期和UICC2010分期標準對鼻咽癌患者放療療效的預測結果相近并都顯著優(yōu)于1992分期。
[Abstract]:Objective at present, a unified clinical staging of nasopharyngeal carcinoma has not been applied internationally. On the basis of 1992 stages, China established a 2008 staging standard in 2008, and the international anticancer Alliance (UICC) issued the latest seventh edition of the 7th edition of nasopharyngeal carcinoma staging standard. However, it is now very short of the comparison of the advantages and disadvantages of the staging standards, which is not beneficial to each other. A retrospective analysis of 347 patients with nasopharyngeal carcinoma, compared with the Chinese 19922008 and UICC 2010 staging criteria, was used to evaluate the value of them in predicting the efficacy of radiotherapy for nasopharyngeal carcinoma.
Methods the clinical data of 347 patients with nasopharyngeal carcinoma without distant metastasis were retrospectively analyzed. T, N and clinical staging were used for each patient with Chinese 19922008 and UICC 2010 staging criteria respectively. The conformance of the number distribution between different stages of different staging criteria was analyzed by Kappa method, and three staging criteria were evaluated by Kaplan-Meier method. The clinical staging, T staging and N staging had the effect on overall survival rate, local recurrence free survival rate and no distant metastasis survival rate, and Log-rank test was different.
Results the clinical staging between the Chinese 2008 staging and the UICC 2010 staging criteria was better than the comparison between the T and the N staging. The Kappa value was 0.700,0.881,0.722, the 2008 staging and the UICC2010 staging were respectively in the clinical staging, T staging, and N staging, respectively. The T staging was better in comparison, and the trend of total survival curves of each clinical stage under the Kappa values of 0.570 and 0.548,0.877 and 0.761,0.485, 0.531.2008 staging and UICC 2010 staging were superior to 1992 stages (x ~2=36.30, P=0.000; Chi ~2=37.73, P=0.000; Chi ~2=33.19, P=0.000); and the total subsistence of stage III and IV in the 1992 stages. The lines interlaced with each other (x ~2=0.401, P=0.526); there were no statistical differences in the local recurrence rates of T1 and T2, T2 and T3, T3 and T4 stages between the three staging standards (P=0.467,0.479,0.174 and Chi ~2=2.096,1.986,1.248, P=0.148,0.159,0.264 and chi square); and the 1992 staging standards 1, there was no statistical difference between N_1 and N_2, N_2 and N_3 (x ~2=3.712,3.113,2.014, P=0.054,0.078,0.156), N_1 and N_2 in the 2008 staging standard, and statistically significant between N_2 and N_3 (chi ~2=10.488,5.059, P=0.001,0.024), and there was a statistical difference between the 2010 staging standards.
Conclusion the consistency of the proportion of Chinese 2008 staging and UICC2010 staging is better than the comparison between their respective and 1992 stages. The three staging criteria can both indicate the efficacy of radiotherapy for nasopharyngeal carcinoma, but the Chinese 2008 staging and UICC2010 staging criteria are similar and significant in predicting the radiotherapy effect of nasopharyngeal carcinoma patients. Better than 1992 stages.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R739.63

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本文編號：2081664