【摘要】：目的：通過回顧性分析局部中晚期鼻咽癌調(diào)強適形放療后影像學(xué)上有殘留的患者預(yù)后情況及預(yù)后相關(guān)因素,尋求預(yù)后不良的因素,進一步指導(dǎo)個體化的綜合治療。 方法和材料：回顧性分析選取2008年8月～2012年1月期間135例在中南大學(xué)湘雅醫(yī)院腫瘤放療科行調(diào)強適形放療(IMRT)的局部中晚期鼻咽癌患者,放療結(jié)束時影像學(xué)證實有殘留。采用SPSS17.0統(tǒng)計軟件,壽命表法計算2年及3年總生存率、無復(fù)發(fā)生存率、無遠處轉(zhuǎn)移生存率,Kaplan-Meier法繪制生存曲線圖。單因素采用Kaplan-Meier方法分析年齡、性別、臨床分期、放療劑量、化療方式、靶向治療、放療增敏劑治療、腫瘤殘留部位、殘留體積、殘留時間等對預(yù)后的影響,組間生存率差異采用Log-rank檢驗。多因素分析采用Cox回歸模型,P0.05為差異有統(tǒng)計學(xué)意義。 結(jié)果：(1)2008年8月～2012年1月在我院初治的135例局部中晚期鼻咽癌行調(diào)強適形放療后局部或區(qū)域影像學(xué)殘留患者2年和3年總生存率(OS)分別為80%和72%,2年和3年無復(fù)發(fā)生存率(RFS)分別為77%和74%,2年和3年無遠處轉(zhuǎn)移生存率(DMFS)分別為74%為69%；(2)單因素分析：2008T分期、PGTVnx處方總劑量、靶向治療、鼻咽部殘留有無、頸部淋巴結(jié)殘留體積、殘留時間為影響無病生存率的相關(guān)因素,2008N分期、2008T分期、2008總分期、PGTVnx處方總劑量、靶向治療、鼻咽部殘留有無、頸部淋巴結(jié)殘留體積、殘留時間為影響總生存率的相關(guān)因素,2008N分期、PGTVnx處方總劑量、PGTVnxD95、靶向治療、鼻咽部殘留有無、頸部淋巴結(jié)殘留體積、殘留時間為影響無復(fù)發(fā)生存的相關(guān)因素,2008N分期、2008T分期、2008總分期、PGTVnx處方總劑量、PGTVnx D95、靶向治療、鼻咽部殘留有無、頸部淋巴結(jié)殘留體積、殘留時間為影響無轉(zhuǎn)移生存率的相關(guān)因素；(3)多因素分析結(jié)果顯示頸部淋巴結(jié)殘留體積是影響鼻咽癌無病生存率、無復(fù)發(fā)生存率、無轉(zhuǎn)移生存率及總生存率的獨立預(yù)后因素,靶向治療是影響總生存的獨立預(yù)后因素,差異均有統(tǒng)計學(xué)意義(P0.05)。 結(jié)論：頸部淋巴結(jié)殘留體積與患者預(yù)后有關(guān)(殘留體積≤5cc患者的生存預(yù)后優(yōu)于殘留體積5cc的患者)；同步放化療加靶向治療的總生存比單純同步放化療差；輔助化療未能提高患者的生存率；放療劑量對生存預(yù)后的影響無統(tǒng)計學(xué)意義。
[Abstract]:Objective: to analyze retrospectively the prognosis and prognostic factors of patients with residual imaging after local intensity modulated conformal radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) in order to find out the factors of poor prognosis and to guide the individualized comprehensive therapy. Methods and materials: from August 2008 to January 2012, a total of 135 patients with locally moderate and advanced nasopharyngeal carcinoma (NPC) who underwent intensity modulated conformal radiotherapy (IMRT) in the Department of tumor radiotherapy, Xiangya Hospital, Central South University, were retrospectively analyzed. The imaging evidence was residual at the end of radiotherapy. The total 2-and 3-year survival rate, recurrence-free survival rate and distant metastasis-free survival rate were calculated by SPSS17.0 statistical software and life table method. The survival curve was plotted by Kaplan-Meier method. The effects of age, sex, clinical stage, radiotherapy dose, chemotherapy mode, targeted therapy, radiosensitizer therapy, residual site, residual volume and residual time on prognosis were analyzed by Kaplan-Meier method. The difference of survival rate between groups was tested by Log-rank test. Multivariate analysis using Cox regression model, P0.05 was statistically significant. Results: (1) from August 2008 to January 2012, the 2-year and 3-year overall survival rates (OS) were 80% and 72%, respectively, for the patients with local or regional residual imaging after intensity modulated conformal radiotherapy in our hospital. The 2-year and 3-year recurrence-free survival rates (RFS) were 77% and 74% respectively, and the 2-year and 3-year distant metastasis-free survival rates (DMFS) were 74% and 69%, respectively. (2) univariate analysis: 2008T stage, total dose of PGTVnx prescription, targeted therapy, residual nasopharynx, residual volume of neck lymph node, residual time were the related factors of disease-free survival rate, 2008N stage, 2008T stage, 2008 total staging. The total dose of PGTVnx prescription, targeted therapy, residual nasopharynx, residual volume of cervical lymph nodes and residual time were the related factors affecting the overall survival rate, 2008N stage, total dose of PGTVnx prescription, targeted PGTVnxD95, therapy and nasopharyngeal residual. The residual volume and time of residual cervical lymph node were the related factors of non-recurrence survival. 2008 N stage, 2008 T stage, 2008 total staging, total dose of PGTVnx prescription, PGTVnx D95, targeted therapy, residual nasopharynx, residual volume of cervical lymph node. Residual time was related to metastasis-free survival rate. (3) the results of multivariate analysis showed that the residual volume of cervical lymph nodes was an independent prognostic factor affecting disease-free survival rate, recurrence-free survival rate, metastasis-free survival rate and total survival rate of nasopharyngeal carcinoma, and targeted therapy was an independent prognostic factor affecting overall survival. The difference was statistically significant (P0.05). Conclusion: the residual volume of cervical lymph nodes is related to the prognosis of patients (the survival prognosis of patients with residual volume 鈮，

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