调强放疗时代升型与降型鼻咽癌的临床特征和生存结局：基于大数据智能平台的分析。

Clinical features and survival outcomes between ascending and descending types of nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: A big-data intelligence platform-based analysis.

机构信息

Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, PR China; Department of Head and Neck Oncology, The Cancer Center of The Fifth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Biomedical Imaging, Zhuhai, PR China.

出版信息

Radiother Oncol. 2019 Aug;137:137-144. doi: 10.1016/j.radonc.2019.04.025. Epub 2019 May 15.

DOI:10.1016/j.radonc.2019.04.025

PMID:31102988

Abstract

PURPOSE

To compare clinical features and survival outcomes in patients with ascending type (type A) and descending type (type D) nasopharyngeal carcinoma (NPC) in the intensity-modulated radiotherapy (IMRT) era.

MATERIALS AND METHODS

A total of 5194 patients with type A and type D NPC treated at Sun Yat-sen University Cancer Center were randomly selected. Tumors that were mainly advanced local disease (T3-4 stage) with early stage cervical lymph node involvement (N0-1 stage) were determined as type A, while tumors with advanced lymph node disease (N2-3 stage) but early stage local invasion (T1-2 stage) were classified as type D NPC. Kaplan-Meier's analysis was used to evaluate survival rates, and log-rank test survival curves were used for comparison. In the multivariate analysis Cox proportional hazard models were developed.

RESULTS

There was a larger proportion of type A tumors (82%) than type D tumors (18%). Compared to patients with type A tumors, those with type D tumors had increased likelihood of distant metastasis, regional recurrence, disease recurrence, and death (P < 0.001 for all), however, not for local recurrence (P < 0.001). The HR (hazard ratio) for death following recurrence of disease for type D tumors were 1.6 compared to type A tumors. Multivariate analysis revealed that elevated EBV DNA, elevated lactate dehydrogenase, alcohol consumption, and no family history of cancer attributed to the development of type D tumors. Annual hazard rate in type A patients increased, peaking at 12-18 months after initial treatment and downward thereafter. Similar trend also occurred in type D during the first 5 years following treatment. Notably, a minor peak was also observed 7-8 years post treatment.

CONCLUSIONS

In the IMRT era, recurrence patterns differed across tumor types. Type D NPC had a more aggressive clinical course and worse outcomes compared with type A NPC.

摘要

目的

比较调强放疗（IMRT）时代上升型（A型）和下降型（D 型）鼻咽癌患者的临床特征和生存结局。

材料与方法

从中山大学肿瘤防治中心随机抽取 5194 例 A 型和 D 型鼻咽癌患者。主要为局部晚期（T3-4 期）且早期颈部淋巴结受累（N0-1 期）的肿瘤被确定为 A 型，而局部侵犯早期（T1-2 期）但淋巴结转移晚期（N2-3 期）的肿瘤被归类为 D 型鼻咽癌。采用 Kaplan-Meier 分析评估生存率，并采用对数秩检验生存曲线进行比较。在多变量分析中，建立了 Cox 比例风险模型。

结果

A型肿瘤（82%）的比例大于 D 型肿瘤（18%）。与 A 型肿瘤患者相比，D 型肿瘤患者远处转移、区域复发、疾病复发和死亡的可能性更高（均 P < 0.001），但局部复发的可能性更低（P < 0.001）。D 型肿瘤复发后死亡的 HR（风险比）为 1.6 与 A 型肿瘤相比。多变量分析显示，EBV DNA 升高、乳酸脱氢酶升高、饮酒和无癌症家族史与 D 型肿瘤的发生有关。A 型患者的年死亡风险增加，在初始治疗后 12-18 个月达到峰值，此后下降。D 型患者在治疗后 5 年内也出现了类似的趋势。值得注意的是，在治疗后 7-8 年也观察到了一个小高峰。