中国南方鼻咽癌患者临床分型系统的提议及预后模型的建立

Proposal of a clinical typing system and generation of a prognostic model in patients with nasopharyngeal carcinoma from Southern China.

作者信息

Sun Peng, Chen Cui, Chen Xin-Lin, Cheng Yi-Kan, Zeng Lei, Zeng Zhi-Jian, Liu Li-Zhi, Su Yong, Gu Mo-Fa

机构信息

State Key Laboratory of Oncology in South China, Guangzhou, Guangdong Province, P. R. China.

出版信息

J BUON. 2014 Apr-Jun;19(2):474-83.

PMID:24965409

Abstract

PURPOSE

To propose a novel clinical typing classification focusing on the distinct progression patterns of nasopharyngeal carcinoma (NPC), to supplement our knowledge of the clinical-biological behavior, to provide useful knowledge for treatment planning, and to contribute to basic research in NPC.

METHODS

632 consecutive patients were retrospectively reviewed and analyzed according to the novel typing system. We considered that NPC can be divided into 5 types as follows: limited (L), ascending (A), descending (D) ascending- descending (mixed) (AD), and distant metastasis types (M). The distribution of these clinical types, their association with Epstein-Barr virus (EBV) serology and prognostic value were explored.

RESULTS

55 (8.70%), 59 (9.34%), 177 (28.01%), 321 (50.79%) and 20 (3.16%) patients were classified as Type L, A, D, AD and M, respectively. EBV (VCA)-IgA titers, EBV early antigen (EA)-IgA serum titers, and capsid antigen lg(EBV DNA) were positively associated with the clinical typing (p<0.05). The 3-year overall survival (OS) rates for Types L, A, D, AD and M were 100, 100, 95.10, 88.20 and 59.30%, respectively (p<0.001). A prognostic model was constructed based on pretreatment lg (EBV DNA) and clinical type, which were independent predictors of OS (multivariate Cox proportional model). The prognostic model stratified patients into 4 risk subgroups. The 3-year OS rates of the low, intermediate, high and extremely high risk groups were 99.5, 90.0, 85.5 and 53.2%, respectively (p<0.001). Compared with the low-risk group, the risk of death was 4.96, 8.75 and 35.9 in the intermediate, high and extremely high risk groups, respectively (p<0.001). The model also predicted OS independently of TNM classification.

CONCLUSION

This novel clinical typing system and prognostic model can supplement TNM classification, and may help design novel treatment strategies, evaluate risk stratification and investigate the varied biological characteristics of NPC.

摘要

目的

提出一种针对鼻咽癌（NPC）不同进展模式的新型临床分型分类方法，以补充我们对临床生物学行为的认识，为治疗方案提供有用信息，并为鼻咽癌的基础研究做出贡献。

方法

根据新型分型系统对632例连续患者进行回顾性分析。我们认为NPC可分为以下5种类型：局限型（L）、上升型（A）、下降型（D）、上升-下降（混合）型（AD）和远处转移型（M）。探讨了这些临床类型的分布、与爱泼斯坦-巴尔病毒（EBV）血清学的关联及其预后价值。

结果

分别有55例（8.70%）、59例（9.34%）、177例（28.01%）、321例（50.79%）和20例（3.16%）患者被分类为L型、A型、D型、AD型和M型。EBV（VCA）-IgA滴度、EBV早期抗原（EA）-IgA血清滴度和衣壳抗原lg（EBV DNA）与临床分型呈正相关（p<0.05）。L型、A型、D型、AD型和M型的3年总生存率（OS）分别为100%、100%、95.10%、88.20%和59.30%（p<0.001）。基于治疗前lg（EBV DNA）和临床类型构建了一个预后模型，它们是OS的独立预测因素（多变量Cox比例模型）。该预后模型将患者分为4个风险亚组。低、中、高和极高风险组的3年OS率分别为99.5%、90.0%、85.5%和53.2%（p<0.001）。与低风险组相比，中、高和极高风险组的死亡风险分别为4.96、8.75和35.9（p<0.001）。该模型还独立于TNM分类预测OS。