He Yu-Xiang, Wang Ying, Cao Peng-Fei, Shen Lin, Zhao Ya-Jie, Zhang Zi-Jian, Chen Deng-Ming, Yang Tu-Bao, Huang Xin-Qiong, Qin Zhou, Dai You-Yi, Shen Liang-Fang
Department of Oncology, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, Hunan, 410008, P. R. China.
Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, P. R. China.
Chin J Cancer. 2016 Nov 16;35(1):96. doi: 10.1186/s40880-016-0159-2.
Gross target volume of primary tumor (GTV-P) is very important for the prognosis prediction of patients with nasopharyngeal carcinoma (NPC), but it is unknown whether the same is true for locally advanced NPC patients treated with intensity-modulated radiotherapy (IMRT). This study aimed to clarify the prognostic value of tumor volume for patient with locally advanced NPC receiving IMRT and to find a suitable cut-off value of GTV-P for prognosis prediction.
Clinical data of 358 patients with locally advanced NPC who received IMRT were reviewed. Receiver operating characteristic (ROC) curves were used to identify the cut-off values of GTV-P for the prediction of different endpoints [overall survival (OS), local relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS)] and to test the prognostic value of GTV-P when compared with that of the American Joint Committee on Cancer T staging system.
The 358 patients with locally advanced NPC were divided into two groups by the cut-off value of GTV-P as determined using ROC curves: 219 (61.2%) patients with GTV-P ≤46.4 mL and 139 (38.8%) with GTV-P >46.4 mL. The 3-year OS, LRFS, DMFS, and DFS rates were all higher in patients with GTV-P ≤46.4 mL than in those with GTV-P > 46.4 mL (all P < 0.05). Multivariate analysis indicated that GTV-P >46.4 mL was an independent unfavorable prognostic factor for patient survival. The ROC curve verified that the predictive ability of GTV-P was superior to that of T category (P < 0.001). The cut-off values of GTV-P for the prediction of OS, LRFS, DMFS, and DFS were 46.4, 57.9, 75.4 and 46.4 mL, respectively.
In patients with locally advanced NPC, GTV-P >46.4 mL is an independent unfavorable prognostic indicator for survival after IMRT, with a prognostic value superior to that of T category.
原发肿瘤大体靶体积（GTV-P）对鼻咽癌（NPC）患者的预后预测非常重要，但对于接受调强放疗（IMRT）的局部晚期NPC患者是否如此尚不清楚。本研究旨在阐明肿瘤体积对接受IMRT的局部晚期NPC患者的预后价值，并找到一个适合预后预测的GTV-P临界值。
回顾了358例接受IMRT的局部晚期NPC患者的临床资料。采用受试者工作特征（ROC）曲线确定GTV-P用于预测不同终点[总生存期（OS）、无局部复发生存期（LRFS）、无远处转移生存期（DMFS）和无病生存期（DFS）]的临界值，并与美国癌症联合委员会T分期系统相比，检验GTV-P的预后价值。
根据ROC曲线确定的GTV-P临界值，将358例局部晚期NPC患者分为两组：GTV-P≤46.4 mL的患者219例（61.2%），GTV-P>46.4 mL的患者139例（38.8%）。GTV-P≤46.4 mL患者的3年OS、LRFS、DMFS和DFS率均高于GTV-P>46.4 mL的患者（均P<0.05）。多因素分析表明，GTV-P>46.4 mL是患者生存的独立不良预后因素。ROC曲线证实，GTV-P的预测能力优于T分类（P<0.001）。GTV-P预测OS、LRFS、DMFS和DFS的临界值分别为46.4、57.9、75.4和46.4 mL。
在局部晚期NPC患者中，GTV-P>46.4 mL是IMRT后生存的独立不良预后指标，其预后价值优于T分类。
