基于磁共振及調(diào)強(qiáng)放射治療背景下的鼻咽癌新T分期研究
發(fā)布時間：2019-04-23 18:01
【摘要】：背景與目的:鼻咽癌是常見的頭頸部惡性腫瘤之一,主要集中在我國南方地區(qū),尤以兩廣地區(qū)多見。而鼻咽癌局部復(fù)發(fā)是影響臨床分期、治療療效及預(yù)后的主要因素之一。近十幾年來,常規(guī)二維放射治療已經(jīng)不再適用并逐漸被調(diào)強(qiáng)放射治療(IMRT)所取代,而2010年發(fā)布的第七版UICC/AJCC鼻咽癌T分期標(biāo)準(zhǔn)主要是基于常規(guī)二維放射治療的數(shù)據(jù)結(jié)果,沒有反映診治手段的變革對分期的影響。因此本研究旨在分析基于磁共振影像的局部解剖結(jié)構(gòu),包括鼻咽部、鼻腔、口咽、咽旁間隙、顱底、翼內(nèi)肌、翼外肌、副鼻竇等結(jié)構(gòu)對接受調(diào)強(qiáng)放射治療的鼻咽癌患者預(yù)后的影響,為臨床治療及研究提供依據(jù),為建立更適應(yīng)調(diào)強(qiáng)放射治療的新的T分期系統(tǒng)提供理論依據(jù)。方法:回顧性分析我院2008年1月至2010年3月經(jīng)病理確診初治無轉(zhuǎn)移的鼻咽癌患者608例,閱讀所有入組患者的MRI影像,結(jié)合查體及初診時的臨床資料按據(jù)鼻咽癌國際第7版UICC/AJCC分期標(biāo)準(zhǔn)進(jìn)行重新分期。生存率的計算采用Kaplan-Meier法,單因素分析采用Log-rank檢驗(yàn),風(fēng)險比計算及多因素分析采用COX模型;分析現(xiàn)行的第7版UICC/AJCC分期系統(tǒng)下對接受調(diào)強(qiáng)放射治療的鼻咽癌患者的預(yù)后存在的弊端,建立基于MRI及IMRT下的鼻咽癌新T分期標(biāo)準(zhǔn),參照臨床分期原則對新T分期系統(tǒng)的合理性進(jìn)行評價。結(jié)果:本組5年隨訪率為94.5%。全組5年DFS為80.1%,LRFS為86.0%,DMFS為81.1%,OS為81.5%。根據(jù)第7版UICC/AJCC分期系統(tǒng),鼻咽癌侵犯周圍結(jié)構(gòu)的分布比例如下:608例患者中,腫物侵犯鼻咽部100%(608/608)、鼻腔34.4%(209/608)、咽旁82.4%(501/608)、口咽部17.6%(107/608)、顱底骨質(zhì)72.2%(439/608)、翼內(nèi)肌65.5%(398/608)、翼外肌32.1%(195/608)、鼻竇23.8%(145/608)、顳下窩13%(79/608)、眼眶15.5%(94/608)、顱神經(jīng)6.9%(142/608)、顱內(nèi)16.8%(102/608)。根據(jù)單因素及多因素分析顯示,鼻腔、口咽部、咽旁間隙、顱底骨質(zhì)、翼內(nèi)肌、翼外肌、顳下窩、鼻竇、眼眶、顱內(nèi)、顱神經(jīng)侵犯均為影響患者預(yù)后的獨(dú)立預(yù)后因素(P0.05)。根據(jù)風(fēng)險差異性及生存曲線分布分析,建議基于磁共振成像以及調(diào)強(qiáng)放射治療相適應(yīng)的鼻咽癌臨床T分期新標(biāo)準(zhǔn)為:T1,鼻咽、咽旁、口咽、鼻腔、顱底、翼內(nèi)肌;T2,翼外肌、鼻竇、顳下窩、眼眶、顱內(nèi)、顱神經(jīng)。相對于第7版UICC/AJCC分期系統(tǒng),推薦的新T分期系統(tǒng)風(fēng)險差異性及分布均衡性均較好,無局部復(fù)發(fā)生存曲線及總生存曲線均能很好地拉開。結(jié)論:推薦的新T分期系統(tǒng)采用了基于磁共振影像及調(diào)強(qiáng)放射治療基礎(chǔ),反映了當(dāng)前鼻咽癌患者最先進(jìn)的診治模式,能較客觀、準(zhǔn)確地預(yù)測鼻咽癌患者的預(yù)后,可作為鼻咽癌臨床新分期探索性的嘗試。
[Abstract]:Background & objective: nasopharyngeal carcinoma (NPC) is one of the most common malignant tumors in head and neck. Local recurrence of nasopharyngeal carcinoma is one of the main factors affecting clinical stage, therapeutic efficacy and prognosis. In recent years, conventional two-dimensional radiotherapy is no longer applicable and gradually replaced by intensity-modulated radiotherapy (IMRT). However, the seventh edition of T-staging standard for nasopharyngeal carcinoma of UICC/AJCC published in 2010 is mainly based on the results of conventional two-dimensional radiotherapy. It does not reflect the influence of the change of diagnosis and treatment on staging. Therefore, the purpose of this study was to analyze the local anatomical structures based on MRI, including nasopharynx, nasal cavity, oropharynx, parapharyngeal space, skull base, internal pterygoid muscle and external pterygoid muscle. The effects of paranasal sinus and other structures on prognosis of nasopharyngeal carcinoma patients undergoing intensity modulated radiotherapy provide evidence for clinical treatment and research, and provide theoretical basis for establishing a new T stage system which is more suitable for intensity modulated radiotherapy. Methods: from January 2008 to March 2010, 608 cases of nasopharynx carcinoma without metastasis diagnosed by pathology were analyzed retrospectively. The MRI images of all the patients were read. Combined with the clinical data of physical examination and initial diagnosis, the patients were re-staging according to the UICC/AJCC staging standard of the 7th edition of nasopharyngeal carcinoma (NPC). The survival rate was calculated by Kaplan-Meier method, Log-rank test was used for univariate analysis, COX model was used for risk ratio calculation and multivariate analysis. To analyze the disadvantages of the current 7 edition UICC/AJCC staging system for the prognosis of nasopharyngeal carcinoma patients undergoing intensity modulated radiotherapy, and to establish a new T staging standard for nasopharyngeal carcinoma based on MRI and IMRT. According to the principle of clinical staging, the rationality of the new T staging system was evaluated. Results: the 5-year follow-up rate was 94.5%. The 5-year DFS, LRFS, DMFS and OS were 80.1%, 86.0%, 81.1% and 81.5%, respectively. According to the seventh edition of the UICC/AJCC staging system, the proportion of nasopharyngeal carcinoma invading the surrounding structures was as follows: 100% (608 / 608) of the 608 patients were involved in the nasopharynx, 34.4% (209 / 608) in the nasal cavity, 82.4% (501 / 608) in the parapharyngeal region, and 62.4% (581 / 608) in the parapharyngeal region. The oropharynx was 17.6% (107 / 608), the skull base was 72.2% (439 / 608), the medial pterygoid muscle was 65.5% (398 / 608), the external pterygoid muscle was 32.1% (195 / 608), the nasal sinus was23.8% (145 / 608), the infratemporal fossa was 13% (79 / 608). Orbit 15.5% (94 / 608), cranial nerve 6.9% (142 / 608), intracranial 16.8% (102 / 608). According to univariate and multivariate analysis, nasal cavity, oropharynx, parapharyngeal space, skull base bone, internal pterygoid muscle, lateral pterygoid muscle, infratemporal fossa, nasal sinus, orbital, intracranial, Cranial nerve invasion was an independent prognostic factor affecting the prognosis of the patients (P0.05). According to the difference of risk and the distribution of survival curve, it is suggested that the new criteria for clinical T staging of nasopharyngeal carcinoma based on MRI and intensity modulated radiotherapy are: T1, nasopharynx, parapharyngeal, oropharynx, nasal cavity, skull base, internal pterygoid muscle; T2, lateral pterygoid muscle, nasal sinus, infratemporal fossa, orbital, intracranial, cranial nerve. Compared with the UICC/AJCC staging system of the 7th edition, the risk difference and distribution balance of the new T staging system are better, and the survival curve without local recurrence and the total survival curve can be well opened. Conclusion: the recommended new T staging system adopts the basis of MRI and intensity modulated radiotherapy, which reflects the most advanced diagnosis and treatment mode of NPC patients, and can predict the prognosis of NPC patients objectively and accurately. It can be used as a new clinical stage of nasopharyngeal carcinoma.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R739.63
本文編號：2463676
[Abstract]:Background & objective: nasopharyngeal carcinoma (NPC) is one of the most common malignant tumors in head and neck. Local recurrence of nasopharyngeal carcinoma is one of the main factors affecting clinical stage, therapeutic efficacy and prognosis. In recent years, conventional two-dimensional radiotherapy is no longer applicable and gradually replaced by intensity-modulated radiotherapy (IMRT). However, the seventh edition of T-staging standard for nasopharyngeal carcinoma of UICC/AJCC published in 2010 is mainly based on the results of conventional two-dimensional radiotherapy. It does not reflect the influence of the change of diagnosis and treatment on staging. Therefore, the purpose of this study was to analyze the local anatomical structures based on MRI, including nasopharynx, nasal cavity, oropharynx, parapharyngeal space, skull base, internal pterygoid muscle and external pterygoid muscle. The effects of paranasal sinus and other structures on prognosis of nasopharyngeal carcinoma patients undergoing intensity modulated radiotherapy provide evidence for clinical treatment and research, and provide theoretical basis for establishing a new T stage system which is more suitable for intensity modulated radiotherapy. Methods: from January 2008 to March 2010, 608 cases of nasopharynx carcinoma without metastasis diagnosed by pathology were analyzed retrospectively. The MRI images of all the patients were read. Combined with the clinical data of physical examination and initial diagnosis, the patients were re-staging according to the UICC/AJCC staging standard of the 7th edition of nasopharyngeal carcinoma (NPC). The survival rate was calculated by Kaplan-Meier method, Log-rank test was used for univariate analysis, COX model was used for risk ratio calculation and multivariate analysis. To analyze the disadvantages of the current 7 edition UICC/AJCC staging system for the prognosis of nasopharyngeal carcinoma patients undergoing intensity modulated radiotherapy, and to establish a new T staging standard for nasopharyngeal carcinoma based on MRI and IMRT. According to the principle of clinical staging, the rationality of the new T staging system was evaluated. Results: the 5-year follow-up rate was 94.5%. The 5-year DFS, LRFS, DMFS and OS were 80.1%, 86.0%, 81.1% and 81.5%, respectively. According to the seventh edition of the UICC/AJCC staging system, the proportion of nasopharyngeal carcinoma invading the surrounding structures was as follows: 100% (608 / 608) of the 608 patients were involved in the nasopharynx, 34.4% (209 / 608) in the nasal cavity, 82.4% (501 / 608) in the parapharyngeal region, and 62.4% (581 / 608) in the parapharyngeal region. The oropharynx was 17.6% (107 / 608), the skull base was 72.2% (439 / 608), the medial pterygoid muscle was 65.5% (398 / 608), the external pterygoid muscle was 32.1% (195 / 608), the nasal sinus was23.8% (145 / 608), the infratemporal fossa was 13% (79 / 608). Orbit 15.5% (94 / 608), cranial nerve 6.9% (142 / 608), intracranial 16.8% (102 / 608). According to univariate and multivariate analysis, nasal cavity, oropharynx, parapharyngeal space, skull base bone, internal pterygoid muscle, lateral pterygoid muscle, infratemporal fossa, nasal sinus, orbital, intracranial, Cranial nerve invasion was an independent prognostic factor affecting the prognosis of the patients (P0.05). According to the difference of risk and the distribution of survival curve, it is suggested that the new criteria for clinical T staging of nasopharyngeal carcinoma based on MRI and intensity modulated radiotherapy are: T1, nasopharynx, parapharyngeal, oropharynx, nasal cavity, skull base, internal pterygoid muscle; T2, lateral pterygoid muscle, nasal sinus, infratemporal fossa, orbital, intracranial, cranial nerve. Compared with the UICC/AJCC staging system of the 7th edition, the risk difference and distribution balance of the new T staging system are better, and the survival curve without local recurrence and the total survival curve can be well opened. Conclusion: the recommended new T staging system adopts the basis of MRI and intensity modulated radiotherapy, which reflects the most advanced diagnosis and treatment mode of NPC patients, and can predict the prognosis of NPC patients objectively and accurately. It can be used as a new clinical stage of nasopharyngeal carcinoma.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R739.63
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 周平婷;康敏;趙婷婷;岳海英;韋婷婷;王仁生;;基于MRI及IMRT下的鼻咽癌新T分期研究[J];中華放射腫瘤學(xué)雜志;2016年10期
2 夏海群;華貽軍;彭醒思;黃培鈺;曹卡加;;誘導(dǎo)化療加放療與同期放化療治療局部晚期鼻咽癌的療效比較[J];中國腫瘤;2016年05期
3 曾雷;龔曉昌;敖帆;湯軼強(qiáng);舒禹先;萬桂芬;肖蕓;廖瑜露;黃敏;謝琛;蔣春靈;李金高;;基于調(diào)強(qiáng)放療的鼻咽癌分期探討[J];中華放射腫瘤學(xué)雜志;2015年03期
4 劉凱;韓艷艷;馬斌林;;鼻咽癌調(diào)強(qiáng)適形放療137例遠(yuǎn)期療效及預(yù)后因素分析[J];臨床耳鼻咽喉頭頸外科雜志;2013年21期
5 王靜石;張征宇;王振常;譚曉天;;鼻咽咀嚼肌間隙病變MRI研究[J];中國臨床醫(yī)學(xué)影像雜志;2013年06期
6 孫久波;郝俊芳;楊新華;于水;董偉;李一明;王興莉;;鼻咽癌常規(guī)放療與調(diào)強(qiáng)放療的臨床研究[J];中華腫瘤防治雜志;2012年19期
7 吳芳;王仁生;馮國生;李桂生;劉美蓮;嚴(yán)浩林;朱錦賢;張勇;胡凱;;初治鼻咽癌調(diào)強(qiáng)放療的前瞻性多中心臨床研究[J];中華放射腫瘤學(xué)雜志;2012年05期
8 梁少波;張寧;李紹恩;盧瑞梁;趙海;張洋;;MR對鼻咽癌局部侵犯規(guī)律及其臨床靶區(qū)勾畫指導(dǎo)意義分析[J];中華腫瘤防治雜志;2012年14期
9 韓晶;沈文榮;葉峰;何俠;;鼻咽癌顱底骨質(zhì)侵犯的CT與MRI檢測對比分析[J];腫瘤學(xué)雜志;2011年01期
10 葛楠;林煥新;胡偉漢;蘇勇;王漢渝;孫瑞;蔡修宇;卜詩益;張欣;邱孟瑤;張偉;羅素;周溢鑫;金廳;;117例鼻咽癌適形調(diào)強(qiáng)放射治療的預(yù)后研究[J];腫瘤研究與臨床;2010年08期
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