Zeng Lei, Tian Yun-Ming, Sun Xue-Ming, Huang Ying, Chen Chun-Yan, Han Fei, Liu Shuai, Lan Mei, Guan Ying, Deng Xiao-Wu, Lu Tai-Xiang
State Key Laboratory Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China.
Strahlenther Onkol. 2014 Oct;190(11):993-1000. doi: 10.1007/s00066-014-0680-7. Epub 2014 May 17.
The purpose of this study was to analyze the mode of relapse patterns and survival of 209 patients with stage IVA and IVB nasopharyngeal carcinoma (NPC).
A total of 209 patients who underwent magnetic resonance imaging (MRI) and were subsequently histologically diagnosed with nondisseminated stage IV NPC received intensity-modulated radiotherapy (IMRT) as their primary treatment and were included in this retrospective study.
Median follow-up time was 65 months (range, 3-108 months). The 5-year overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) rates for patients with stage IVA and stage IVB NPC were 72.7 vs. 60.0 % (p = 0.319), 62.9 vs. 51.3 % (p = 0.070), 82.9 vs. 93.1 % (p = 0.070), 82.9 vs. 82.9 % (p = 0.897), 76.4 vs. 58.5 % (p = 0.003), respectively. Age older than 44 years was found to be a statistically significant adverse independent prognostic factor for OS. Patients with advanced N status had worse OS, DFS, and DMFS rates. Patients with a primary gross tumor volume (GTV-P) ≥ 55.11 ml had worse OS, DFS, and LRRFS rates.
The results of treating stage IVA NPC with IMRT were excellent. Distant metastasis remains the most difficult treatment challenge for patients with stage IVA and IVB NPC, and more effective systemic chemotherapy should be explored.
本研究旨在分析209例IVA期和IVB期鼻咽癌（NPC）患者的复发模式及生存情况。
共有209例接受了磁共振成像（MRI）检查，随后经组织学诊断为非播散性IV期NPC的患者，接受调强放疗（IMRT）作为主要治疗方法，并纳入本回顾性研究。
中位随访时间为65个月（范围3 - 108个月）。IVA期和IVB期NPC患者的5年总生存率（OS）、无病生存率（DFS）、局部无复发生存率（LRFS）、区域无复发生存率（LRRFS）和远处转移无复发生存率（DMFS）分别为72.7%对60.0%（p = 0.319）、62.9%对51.3%（p = 0.070）、82.9%对93.1%（p = 0.070）、82.9%对82.9%（p = 0.897）、76.4%对58.5%（p = 0.003）。发现年龄大于44岁是OS的一个具有统计学意义的不良独立预后因素。N分期较晚的患者OS、DFS和DMFS率较差。原发大体肿瘤体积（GTV-P）≥55.11 ml的患者OS、DFS和LRRFS率较差。
IMRT治疗IVA期NPC的效果良好。远处转移仍然是IVA期和IVB期NPC患者最棘手的治疗挑战，应探索更有效的全身化疗方法。
