同期化疗和调强放疗治疗鼻咽癌患者肿瘤体积的预后价值。
Prognostic value of tumor volume for patients with nasopharyngeal carcinoma treated with concurrent chemotherapy and intensity-modulated radiotherapy.
机构信息
Department of Radiation Oncology, Tumor Hospital, Xiangya School of Medicine, Central South University, Changsha, 410013, People's Republic of China.
出版信息
J Cancer Res Clin Oncol. 2014 Jan;140(1):69-76. doi: 10.1007/s00432-013-1542-x. Epub 2013 Oct 31.
PURPOSE
We aimed to analyze prognostic factors in patients with nasopharyngeal carcinoma (NPC) treated with concurrent chemotherapy and intensity-modulated radiotherapy (IMRT); in addition, we aimed to elucidate the value of primary gross tumor volume (GTVp) in predicting prognosis of patients.
METHODS
Between February 2001 and December 2008, 321 patients with NPC treated with concurrent chemotherapy and IMRT were analyzed retrospectively. GTVp was calculated from treatment planning computed tomography scans. A receiver operating characteristics (ROC) curve was used to determine the best cutoff point of GTVp.
RESULTS
The 5-year local failure-free survival (LFFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) for NPC patients were 93.8, 80.1, 73.0, and 83.7 %, respectively. Univariate and multivariate analyses indicated that GTVp had exhibited a statistically significant correlation with LFFS, DMFS, DFS, and OS (P < 0.05, all), whereas T classification was not an independent prognostic factor. According to ROC curve analysis, 49 and 19 mL were determined as the cutoff points of GTVp for local control and distant metastasis, respectively. Based on this, 321 patients were divided into three volume subgroups. LFFS, DMFS, DFS, and OS demonstrated significant differences among patients in different volume subgroups (P < 0.001, all) and were superior to T classification for predicting prognosis of NPC patients.
CONCLUSIONS
Primary gross tumor volume is an independent prognostic factor in local control, distant metastasis, disease-free survival, and overall survival in NPC. An adjusted TNM staging system that includes GTVp as a quantitative indicator to evaluate prognosis is warranted.
目的
分析接受同期化疗和调强放疗（IMRT）治疗的鼻咽癌（NPC）患者的预后因素；此外，我们旨在阐明原发肿瘤大体体积（GTVp）预测患者预后的价值。
方法
回顾性分析 2001 年 2 月至 2008 年 12 月期间 321 例接受同期化疗和 IMRT 治疗的 NPC 患者。GTVp 是根据治疗计划 CT 扫描计算得出的。使用受试者工作特征（ROC）曲线确定 GTVp 的最佳截断值。
结果
NPC 患者的 5 年局部无失败生存率（LFFS）、无远处转移生存率（DMFS）、无病生存率（DFS）和总生存率（OS）分别为 93.8%、80.1%、73.0%和 83.7%。单因素和多因素分析表明，GTVp 与 LFFS、DMFS、DFS 和 OS 均具有显著相关性（P<0.05，均），而 T 分类不是独立的预后因素。根据 ROC 曲线分析，49 和 19 mL 分别被确定为局部控制和远处转移的 GTVp 截断点。基于此，将 321 例患者分为三个体积亚组。不同体积亚组的患者 LFFS、DMFS、DFS 和 OS 均有显著差异（P<0.001，均），并且在预测 NPC 患者预后方面优于 T 分类。
结论
原发肿瘤大体体积是 NPC 局部控制、远处转移、无病生存和总生存的独立预后因素。需要建立一个包括 GTVp 作为定量指标的调整后的 TNM 分期系统来评估预后。
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