【摘要】：研究目的:探討調(diào)強(qiáng)放射治療條件下鼻咽癌原發(fā)腫瘤體積對(duì)患者預(yù)后的影響。 研究方法:我院自2004年1月至2006年12月共有330例UICC I-IVB期鼻咽癌初治患者接受調(diào)強(qiáng)放射治療,入組本研究。所有患者治療前均行CT增強(qiáng)掃描,掃描圖像資料輸人三維治療計(jì)劃系統(tǒng)進(jìn)行腫瘤輪廓勾畫,勾畫完成后系統(tǒng)自動(dòng)進(jìn)行三維重建和腫瘤體積計(jì)算。我們?cè)谘芯恐杏檬茉囌吖ぷ魈卣髑€( receive operating characteristic curve, ROC曲線)確定原發(fā)腫瘤體積的臨床應(yīng)用截點(diǎn),用Kaplan-Meier生存分析和COX比例風(fēng)險(xiǎn)回歸模型分析原發(fā)腫瘤體積與患者預(yù)后的關(guān)系。 研究結(jié)果:330例鼻咽癌患者所測(cè)平均原發(fā)腫瘤體積是34.2ml(0.4-153.7)。對(duì)于T1、T2、T3和T4患者,平均原發(fā)腫瘤體積分別是10.4ml(0.4-40.6)、21.9ml(3.6-75.3)、34.0ml(4.6-102.1)和68.2ml(18.9-153.7)。在2002UICC鼻咽癌T分期框架內(nèi),所有入組患者被分為4組,分組的截點(diǎn)是由ROC曲線確定的,分別是10ml、25ml、50ml。建立在原發(fā)腫瘤體積分組基礎(chǔ)上,三年總生存率對(duì)于四組患者分別是88.6%, 90.0%, 91.2%和74.2% (p=0.005)。前三組累積生存率曲線非常貼近,但與第四組曲線分離明顯。對(duì)于第四組患者即原發(fā)腫瘤體積超過(guò)50ml的患者,生存率較前三組明顯下降。多因素分析中亦證實(shí)原發(fā)腫瘤體積同N分期一樣,是影響患者生存的一個(gè)獨(dú)立預(yù)后因素。 結(jié)論:鼻咽癌原發(fā)腫瘤體積是影響患者生存的一個(gè)極其重要的預(yù)后因素。臨床使用UICC分期評(píng)估患者預(yù)后和治療方案時(shí),應(yīng)該充分考慮到患者原發(fā)腫瘤體積對(duì)預(yù)后的影響。我們基于該研究基礎(chǔ)上建議考慮將原發(fā)腫瘤體積作為一個(gè)新的分期指標(biāo),補(bǔ)充和完善現(xiàn)行的鼻咽癌分期。
[Abstract]:Objective: to investigate the effect of primary tumor volume on prognosis of nasopharyngeal carcinoma (NPC) after intensity modulated radiotherapy. Methods: from January 2004 to December 2006, 330 patients with nasopharyngeal carcinoma (NPC) at UICC I-IVB stage received intensity modulated radiotherapy (IMRT). All the patients underwent CT enhanced scanning before treatment, and the scanning images were transferred into the three-dimensional treatment planning system to outline the tumor profile. After the drawing was completed, the system carried out 3D reconstruction and tumor volume calculation automatically. In our study, we determined the clinical application cutoff point of primary tumor volume by using the operating characteristic curve (receive operating characteristic curve, ROC curve), and analyzed the relationship between primary tumor volume and patients' prognosis by Kaplan-Meier survival analysis and COX proportional risk regression model. Results the mean primary tumor volume in 330 patients with nasopharyngeal carcinoma was 34.2ml (0.4-153.7). The mean primary tumor volume of patients with T _ (1) T _ (2) T _ 3 and T _ 4 were 10.4ml (0.4-40.6) ~ 21.9ml (3.6-75.3) and 68.2ml (18.9-153.7), respectively, of 34.0ml (4.6-102.1) and 18.9-153.7, respectively. Within the framework of T stage of 2002UICC nasopharyngeal carcinoma, all the patients were divided into 4 groups. The cut-off point of the group was determined by the ROC curve, which was 10ml / 25ml / 50ml, respectively. On the basis of primary tumor volume grouping, the three year overall survival rate for the four groups was 88.6, 90.0, 91.2% and 74.2%, respectively (p0.005). The cumulative survival rate curve of the first three groups was very close to that of the fourth group. The survival rate of the fourth group of patients whose primary tumor volume exceeded 50ml was significantly lower than that of the first three groups. Multivariate analysis also confirmed that primary tumor volume was an independent prognostic factor as N stage. Conclusion: primary tumor volume of nasopharyngeal carcinoma is an important prognostic factor for survival of nasopharyngeal carcinoma. The effect of primary tumor volume on prognosis should be fully taken into account when UICC staging is used to evaluate the prognosis and treatment of patients. Based on this study, we suggest to consider primary tumor volume as a new staging index to supplement and improve the current NPC staging.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R739.63

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