Chang Hui, Wei Jia-Wang, Chen Kai, Zhang Shu, Han Fei, Lu Li-Xia, Xiao Wei-Wei, Gao Yuan-Hong
Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine; Guangzhou, Guangdong 510060, China.
J Cancer. 2018 Jan 11;9(4):702-710. doi: 10.7150/jca.22836. eCollection 2018.
In the era of intensity-modulated radiotherapy (IMRT), distant metastasis remains the major cause of death from nasopharyngeal carcinoma (NPC). This study aimed to evaluate the clinical value of pretreatment serum lipid profiles in predicting clinical outcome of NPC. A total of 1927 consecutive patients who had untreated NPC and completed radical IMRT between Jan. 2010 and Dec. 2011 were retrospectively reviewed. Pretreatment serum lipid indexes including total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein A-I (apoAI) and apolipoprotein B were analyzed for their association with survivals, together with the clinical features (age, sex, pathological type, anemia, chemotherapy sequence and Epstein-Barr virus deoxyribonucleic acid). Hazard ratio (HR) and 95% confidence interval (CI) were calculated for each independent prognosticator. After univariate and multivariate survival analysis, low apoAI level (< 1.125 mmol/L) appeared to predict poor 5-year overall survival (OS), disease-free survival (DFS) and distant-metastasis-free survival (DMFS).The HRs were 1.549 (95% CI, 1.137-2.109), 1.293 (95% CI, 1.047-1.597) and 1.288 (95% CI, 1.022-1.623), respectively. Subgroup survival analysis showed that the apoAI maintained predicting independence for OS, DFS and DMFS in patients with locally advanced NPC, even in those treated with concurrent chemoradiotherapy. NPC patient with low serum level of pretreatment apoAI might be at risk of distant metastasis. Treatment aiming to eradicate distant metastasis might improve survival of these patients.
在调强放射治疗（IMRT）时代，远处转移仍然是鼻咽癌（NPC）死亡的主要原因。本研究旨在评估治疗前血脂谱对预测NPC临床结局的临床价值。回顾性分析了2010年1月至2011年12月期间连续1927例未经治疗且完成根治性IMRT的NPC患者。分析治疗前血脂指标，包括总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白A-I（apoAI）和载脂蛋白B与生存率的相关性，以及临床特征（年龄、性别、病理类型、贫血、化疗顺序和EB病毒脱氧核糖核酸）。计算每个独立预后因素的风险比（HR）和95%置信区间（CI）。单因素和多因素生存分析后，低apoAI水平（<1.125 mmol/L）似乎预示着5年总生存（OS）、无病生存（DFS）和无远处转移生存（DMFS）较差。HR分别为1.549（95%CI，1.137 - 2.109）、1.293（95%CI，1.047 - 1.597）和1.288（95%CI，1.022 - 1.623）。亚组生存分析表明，即使在接受同步放化疗的局部晚期NPC患者中，apoAI对OS、DFS和DMFS仍保持预测独立性。治疗前血清apoAI水平低的NPC患者可能有远处转移风险。旨在根除远处转移的治疗可能会改善这些患者的生存。
