基于调强放射治疗的鼻咽癌新T分期系统：一项前瞻性多中心临床研究的结果
A new T staging system for nasopharyngeal carcinoma based on intensity-modulated radiation therapy: results from a prospective multicentric clinical study.
作者信息
Kang Min, Zhou Pingting, Wei Tingting, Zhao Tingting, Long Jianxiong, Li Guisheng, Yan Haolin, Feng Guosheng, Liu Meilian, Zhu Jinxian, Wang Rensheng
机构信息
Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University Nanning 530021, Guangxi, P. R. China.
School of Public Health, Guangxi Medical University Nanning 530021, Guangxi, P. R. China.
出版信息
Am J Cancer Res. 2017 Feb 1;7(2):346-356. eCollection 2017.
PURPOSE
This prospective multicentric study aimed to establish a new clinical T staging standard for nasopharyngeal carcinoma (NPC) based on intensity-modulated radiotherapy (IMRT).
METHODS AND MATERIALS
Between January 2006 and December 2009, four hundred and ninety-two NPC patients undergoing IMRT were staged according to the seventh edition of the UICC/AJCC staging system. The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used to compare survival differences.
RESULTS
The 5-year overall survival (OS), disease-free survival (DFS), recurrence-free survival (RFS), and distant metastasis-free survival (DMSF) rates were 80.5%, 78.6%, 94.1%, and 84.3%, respectively. Univariate and multivariate analyses showed that the invasion of the nasal cavity, parapharyngeal space, oropharynx, skull base, internal pterygoid muscle, external pterygoid muscle, paranasal sinus, infratemporal fossa, orbit, cranial nerves, cavernous sinus, and intracalvarium were independent prognostic factors (P<0.05). According to the results of risk variety and survival curves, we suggest that the new T staging system for NPC based on magnetic resonance imaging and intensity modulated radiation therapy can be classified as T1 (nasopharynx, nasal cavity, parapharyngeal space, oropharynx, skull base and internal pterygoid muscle) and T2 (external pterygoid muscle, paranasal sinus, infratemporal fossa, orbit, cranial nerves, cavernous sinus and intracalvarium). Compared to the seventh edition of UICC/AJCC staging system, our new recommended staging system performs better in risk difference and distribution balance. Furthermore, the differences between the substages of 5-year curves of LRFS, DMFS and OS were all statistically significant in our new recommended staging system.
CONCLUSIONS
Our new recommended staging system is more adaptable to IMRT and can predict the prognosis of NPC patient in a more objective and accurate manner.
目的
本前瞻性多中心研究旨在基于调强放射治疗（IMRT）建立一种新的鼻咽癌（NPC）临床T分期标准。
方法与材料
2006年1月至2009年12月期间，492例行IMRT的NPC患者根据UICC/AJCC分期系统第七版进行分期。采用Kaplan-Meier法计算生存率，采用对数秩检验比较生存差异。
结果
5年总生存率（OS）、无病生存率（DFS）、无复发生存率（RFS）和无远处转移生存率（DMSF）分别为80.5%、78.6%、94.1%和84.3%。单因素和多因素分析显示，鼻腔、咽旁间隙、口咽、颅底、翼内肌、翼外肌、鼻窦、颞下窝、眼眶、脑神经、海绵窦和颅内侵犯是独立的预后因素（P<0.05）。根据风险差异和生存曲线结果，我们建议基于磁共振成像和调强放射治疗的NPC新T分期系统可分为T1（鼻咽、鼻腔、咽旁间隙、口咽、颅底和翼内肌）和T2（翼外肌、鼻窦、颞下窝、眼眶、脑神经、海绵窦和颅内）。与UICC/AJCC分期系统第七版相比，我们新推荐的分期系统在风险差异和分布平衡方面表现更好。此外，在我们新推荐的分期系统中，LRFS、DMFS和OS的5年曲线亚组之间的差异均具有统计学意义。
结论
我们新推荐的分期系统更适用于IMRT，能够更客观、准确地预测NPC患者的预后。
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