调强放疗治疗鼻咽癌患者中肿瘤总体积的预后价值

Prognostic value of total tumor volume in patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy.

作者信息

Liang Shao-Bo, Teng Jian-Jian, Hu Xue-Feng, Yang Xing-Li, Luo Min, Fang Xiao-Na, Liu Dong-Sheng, Chen Yong, Fu Li-Wu

机构信息

State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.

Department of Radiation Oncology, Cancer Center, First People's Hospital of Foshan Affiliated to Sun Yat-sen University, Foshan, China.

出版信息

BMC Cancer. 2017 Jul 28;17(1):506. doi: 10.1186/s12885-017-3480-5.

BACKGROUND

Few studies have evaluated the prognostic value of total tumor volume (TTV), which reflects both the primary tumor volume and nodal tumor volume, in NPC. Furthermore, the relationship between TTV and survival remains unknown. The purpose of this study was to evaluate the prognostic value of TTV in patients with NPC treated with intensity-modulated radiation therapy (IMRT).

METHODS

TTV was retrospectively assessed in 455 patients with newly diagnosed, non-metastatic NPC. All patients were treated using IMRT; 91.1% (288/316) of patients with stage III-IVb also received cisplatin-based chemotherapy. Receiver operating characteristic (ROC) curves were used to identify the optimal TTV cut-off point and examine the prognostic value of combined TTV with current clinical stage.

RESULTS

Mean TTV was 11.1 cm (range, 0.3-27.9 cm) in stage I, 22.5 cm (1.3-92.4 cm) in stage II, 40.6 cm in stage III (3.2-129.2 cm), and 77.5 cm in stage IVa-b (7.1-284.1 cm). For all patients, the 4-year estimated FFS, OS, DMFS, and LRRFS rates for patients with a TTV ≤ 28 vs. > 28 cm were 93 vs. 71.4% (P < 0.001), 95.1 vs. 75.4% (P < 0.001), 94.5 vs. 79.4% (P < 0.001), and 96.2 vs. 88% (P = 0.001). TTV was an independent prognostic factor for FFS, OS, DMFS and LRRFS in all patients. In stage III-IVb, 4-year estimated FFS, OS, DMFS, and LRRFS for a TTV ≤28 vs. >28 cm were 88.9 vs. 70.5% (P = 0.001), 96.2 vs. 72.7% (P < 0.001), 91.2 vs. 78.3% (P = 0.008), and 93.8 vs. 87.6% (P = 0.063). TTV was an independent prognostic factor for FFS, OS and DMFS in stage III-IVb. Receiver operating characteristic (ROC) curve analysis curves revealed adding TTV to clinical stage had superior prognostic value for treatment failure compared to clinical stage alone (P = 0.016).

CONCLUSIONS

TTV is an important prognosticator for treatment outcome and significantly improves the prognostic value of the current staging system for patients with NPC treated with IMRT.

背景

很少有研究评估反映原发肿瘤体积和淋巴结肿瘤体积的总肿瘤体积（TTV）在鼻咽癌（NPC）中的预后价值。此外，TTV与生存率之间的关系仍不清楚。本研究的目的是评估TTV在接受调强放射治疗（IMRT）的NPC患者中的预后价值。

方法

对455例新诊断的非转移性NPC患者进行回顾性TTV评估。所有患者均接受IMRT治疗；Ⅲ-Ⅳb期患者中91.1%（288/316）也接受了以顺铂为基础的化疗。采用受试者工作特征（ROC）曲线确定最佳TTV切点，并检验联合TTV与当前临床分期的预后价值。

结果

Ⅰ期患者的平均TTV为11.1cm（范围0.3-27.9cm），Ⅱ期为22.5cm（1.3-92.4cm），Ⅲ期为40.6cm（3.2-129.2cm），Ⅳa-b期为77.5cm（7.1-284.1cm）。所有患者中，TTV≤28cm与>28cm的患者4年估计无进展生存率（FFS）、总生存率（OS）、远处转移无进展生存率（DMFS）和局部区域复发无进展生存率（LRRFS）分别为93%对71.4%（P<0.001）、95.1%对75.4%（P<0.001）、94.5%对79.4%（P<0.001）、96.2%对88%（P=0.001）。TTV是所有患者FFS、OS、DMFS和LRRFS的独立预后因素。在Ⅲ-Ⅳb期，TTV≤28cm与>28cm的患者4年估计FFS、OS、DMFS和LRRFS分别为88.9%对70.5%（P=0.001）、96.2%对72.7%（P<0.001）、91.2%对78.3%（P=0.008）、93.8%对87.6%（P=0.063）。TTV是Ⅲ-Ⅳb期患者FFS、OS和DMFS的独立预后因素。ROC曲线分析显示，与单独的临床分期相比，将TTV加入临床分期对治疗失败具有更好的预后价值（P=0.016）。