Lee Ching-Chih, Ho Hsu-Chueh, Lee Moon-Sing, Hsiao Shih-Hsuan, Hwang Juen-Haur, Hung Shih-Kai, Chou Pesus
Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC.
Auris Nasus Larynx. 2008 Sep;35(3):376-80. doi: 10.1016/j.anl.2007.10.010. Epub 2008 Jan 30.
To elucidate the effect of primary tumor volume (PTV) on treatment outcomes in patients with nasopharyngeal carcinoma (NPC) who were treated with radiotherapy or concurrent chemoradiotherapy. The TNM staging system developed by American Joint Committee of Cancer (AJCC) is universally used and accepted but its prediction of prognosis in NPC receives a lot of challenge. Primary tumor volume had been reported to have close relationship with prognosis of head and neck cancer. We may predict prognosis of NPC with PTV.
From 1999 to 2006, 91 patients with newly diagnosed NPC who were treated with radiotherapy or CCRT were enrolled in the study. Computed tomography-derived or magnetic resonance-derived primary tumor volume was calculated. The correlation between AJCC disease stage, primary tumor volume and disease-specific survival were analyzed. Multivariate analyses using the Cox proportional hazard model was performed.
The median primary tumor volume for the whole series was 11.39 ml (range 1.25-166.58 ml). The median primary tumor volume was 2.69 ml in T1 disease, 10.14 ml in T2 disease, 15.41 ml in T3 disease, and 26.69 ml in T4 disease. Hazard ratio increased with tumor volume, ranging from 5.91 (95% confidence interval (95% CI) 1.13-26.43) for tumor volumes between 20 ml and 40 ml, and 15.72 (95% CI, 3.82-61.05) for tumor volumes >40 ml. With both tumor volume and T classification in the same Cox regression model, only tumor volume remained statistically significant in the prognosis of NPC.
Primary tumor volume has closer relationship with survival rates of patients with NPC. Calculation of primary tumor volume may be further considered to improve the current staging system.
阐明鼻咽癌（NPC）患者接受放疗或同步放化疗时，原发肿瘤体积（PTV）对治疗结果的影响。美国癌症联合委员会（AJCC）制定的TNM分期系统被广泛应用和接受，但其对鼻咽癌预后的预测面临诸多挑战。据报道，原发肿瘤体积与头颈癌的预后密切相关。我们可以用PTV来预测鼻咽癌的预后。
1999年至2006年，91例新诊断的接受放疗或同步放化疗的鼻咽癌患者纳入本研究。计算计算机断层扫描或磁共振成像得出的原发肿瘤体积。分析AJCC疾病分期、原发肿瘤体积与疾病特异性生存率之间的相关性。采用Cox比例风险模型进行多因素分析。
整个队列的原发肿瘤体积中位数为11.39 ml（范围1.25 - 166.58 ml）。T1期疾病的原发肿瘤体积中位数为2.69 ml，T2期为10.14 ml，T3期为15.41 ml，T4期为26.69 ml。风险比随肿瘤体积增加，20 ml至40 ml肿瘤体积的风险比为5.91（95%置信区间[95% CI] 1.13 - 26.43），肿瘤体积＞40 ml的风险比为15.72（95% CI，3.82 - 61.05）。在同一Cox回归模型中纳入肿瘤体积和T分类时，仅肿瘤体积在鼻咽癌预后方面仍具有统计学意义。
原发肿瘤体积与鼻咽癌患者的生存率关系更为密切。可进一步考虑计算原发肿瘤体积以改进当前的分期系统。
