本文選題：鼻咽癌 + 分期��； 參考：《廣西醫(yī)科大學》2017年碩士論文

【摘要】：目的:通過回顧性分析345例初治鼻咽癌調強放療患者的臨床及生存資料,比較鼻咽癌中國2008分期(以下簡稱2008分期)與UICC2010分期(以下簡稱2010分期)標準的合理性,為鼻咽癌分期系統(tǒng)的修訂提供進一步依據(jù)。方法:收集2011年11月-2012年12月在廣西醫(yī)科大學第一附屬醫(yī)院放療科經病理證實、首診并符合入組條件的370例鼻咽癌患者資料(隨訪到345人,隨訪率93.2%),對所有患者分別按照2008及2010分期標準進行分期。采用Kappa法進行各期病例分布的一致性檢驗,Kaplan-Meier法計算各種生存率,Log-rank法進行差異性檢驗。結果:(1)345例鼻咽癌患者3年總生存率(OS)、無復發(fā)生存率(RFS)、無遠處轉移生存率(DMFS)分別為:81.4%、93.4%、86.7%。(2)兩種分期標準臨床、T及N分期Kappa值分別為0.659、0.727、0.811(P值均=0.000),臨床及T分期一致性中等,N分期一致性最好。(3)2008分期與2010分期的臨床分期、T分期及N分期總生存曲線走勢良好(P0.05),但各組間差異均不明顯。2008分期中,II期與IVa、III期與IVa期差異有統(tǒng)計學意義;T1與T4、T2與T4、T3與T4之間差異有統(tǒng)計學意義;N0與N3、N1b與N2、N1b與N3之間差異有統(tǒng)計學意義,其余各期均無統(tǒng)計學意義。2010分期中II期與IVa、II期與IVb期、III期與IVb期有統(tǒng)計學意義;T1與T4、T2與T4之間差異有統(tǒng)計學意義;N0與N2、N0與N3b、N1與N2、N1與N3b之間有統(tǒng)計學差異,其余各期均無統(tǒng)計學差異。(4)兩種分期標準中臨床分期、T分期及2008分期標準N分期的無復發(fā)生存曲線相互交叉,差異無統(tǒng)計學意義(P0.05);2010分期標準N分期無復發(fā)生存曲線無明顯重疊(P0.05),僅N1與N3b之間有統(tǒng)計學差異,其余各期均無統(tǒng)計學意義。(5)兩種分期系統(tǒng)中T分期、臨床分期的無遠處轉移生存曲線相互重疊,差異無統(tǒng)計學意義(P0.05);N分期能較好的預測無遠處轉移生存情況(P0.05)。2008分期中N1a與N1b曲線相互靠攏,N0與N2、N0與N3、N1a與N3、N1b與N3之間差異有統(tǒng)計學差異,其余各期均無統(tǒng)計學差異;2010分期中,N3a與N3b相互交叉,N0與N2、N0與N3a、N0與N3b、N1與N2、N1與N3a、N1與N3b之間差異有統(tǒng)計學意義,其余各期均無統(tǒng)計學差異。將2008分期中N1a與N1b融合,2010分期N3a與N3b融合后,兩種分期無轉移生存各曲線分開良好,除N0與N1、N2與N3之間無統(tǒng)計學差異,其余各期均有意義。結論:1.中國2008分期與UICC2010分期標準的N分期具有較好的一致性,臨床及T分期一致性中等。2.兩種分期標準臨床分期、T分期、N分期均能預測總生存率;N分期均能預測無遠處轉移生存率,但各組間差異不顯著。3.兩種分期標準臨床分期、T分期、N分期對無復發(fā)生存率影響較少;臨床分期、T分期對無遠處轉移生存率影響較少。4.兩種分期標準對鼻咽癌調強放療療效預測結果相近。
[Abstract]:Objective: to analyze retrospectively the clinical and survival data of 345 patients with nasopharyngeal carcinoma treated with intensity modulated radiotherapy (IMRT), and to compare the reasonableness of Chinese 2008 staging (2008 staging) and UICC2010 staging (2010 stage) for nasopharyngeal carcinoma. To provide further basis for the revision of nasopharyngeal carcinoma staging system. Methods: from November 2011 to December 2012, 370 patients with nasopharyngeal carcinoma (NPC) who were confirmed pathologically by radiotherapy in the first affiliated Hospital of Guangxi Medical University were collected. The follow-up rate was 93. 2%. All patients were staging according to the 2008 and 2010 staging criteria. Kappa method was used to test the consistency of case distribution. Kaplan-Meier method was used to calculate the survival rate and Log-rank method was used to test the differences. Results the 3-year overall survival rate and recurrence free survival rate and distant metastasis survival rate in 345 patients with nasopharyngeal carcinoma were 0.6590.270.811P and 0.0000.000 respectively. The Kappa values of the two staging criteria were 0.659and 0.7270.811P, respectively. The overall survival curve of T stage and N stage was better than that of 2010 stage, but there was no significant difference between the two groups. There were significant differences in T 1 and T 4 T 2 between 2008 stage and IVa stage. There was significant difference between T _ 4T _ 3 and T _ 4. There was significant difference between N0 and N3N _ 1b and N _ 2N _ 1b and N _ 3. There was no statistical significance in the other stages. There were statistical differences between stage II and stage Iva II and stage IVb, stage III and stage IVb. There were significant differences between T1 and T4T _ 2 and T _ 4. There were significant differences between N0 and N2N0 and N3bN1and N2N3b, and between N3b and N2N _ 1, there was no significant difference between N0 and N2N _ 0 and N2N _ 2N _ 1 and N3b. There was no statistical difference in other stages. (4) the recurrence free survival curves of clinical staging T stage and 2008 stage N stage were intersected. There was no significant difference in the survival curve of the standard N staging without recurrence. There was only a statistical difference between N1 and N3b, and there was no significant difference in T staging in the other stages. The survival curve without distant metastasis in clinical staging overlapped with each other. There was no significant difference between P0.05N stage and N3N1a stage. The N1a and N1b curves were close to N0 and N2N0 and N3N1a and N3N1b were closely related to N3 in the stage of P0.05. 2008, and there was a significant difference between N1a and N1b and N3N1b, N3, N1a, N1a, N1b, N1b, N1b and N3. There was no statistical difference between N3a and N3b in the other stages. There was no significant difference between N3a and N3b in 2010 stage. After the fusion of N1a and N1b in stage 2008 and stage N3a and N3b in 2010, the survival curves of N1a and N3b in the two stages were well separated, except that there was no statistical difference between N0 and N1N _ 2 and N _ 3, the other stages were significant. Conclusion 1. There was good consistency between 2008 staging in China and N staging in UICC2010 staging standard. The consistency of clinical and T staging was moderate. 2. 2. Both types of clinical staging and T staging and N staging could predict the overall survival rate and N stage, but there was no significant difference between the two groups. Two kinds of clinical staging standard T staging and N staging had little effect on recurrence free survival rate, and clinical staging T stage had less effect on distant metastasis survival rate. The two staging criteria were similar in predicting the therapeutic effect of intensity modulated radiotherapy for nasopharyngeal carcinoma (NPC).
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.63

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