Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Shanghai 200032, China.
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Shanghai 200032, China.
Oral Oncol. 2020 Jan;100:104478. doi: 10.1016/j.oraloncology.2019.104478. Epub 2019 Nov 20.
This study aimed to explore the prognostic value of extensive invasion of primary tumor volume for local control in patients with T3-4 NPC receiving intensity-modulated radiotherapy (IMRT).
Between January 2009 and December 2015, initial volume of GTV-P, the confined and extensive invasion part of GTV-P (GTV-C and GTV-E) were obtained from 159 prospectively enrolled non-metastatic T3-4 NPC patients. GTV-E included the tumor with infiltration of bony structures at skull base, cervical vertebra, paranasal sinuses or with intracranial extension. GTV-C was calculated by the subtraction of GTV-E from GTV-P. The effects of tumor volume levels on local control rate (LC) were evaluated by Kaplan-Meier method and multivariate analysis.
GTV-P (P = 0.015) and GTV-E (P = 0.001) were significantly correlated with local failure, while GTV-C (P = 0.494) was not. Then optimal cut-off values of GTV-P (43 mL) and GTV-E (22 mL) were determined by receiver operating characteristic curve analysis. Patients with small (<22 mL) GTV-E achieved better 5-year LC rate than those with large (≥22 mL) GTV-E (96.3% vs.76.1%, P < 0.001), but no significant difference was found between patients with small (<43 mL) and large (≥43 mL) GTV-P (95.9% vs. 85.5%, P = 0.094). Multivariate analysis also demonstrated large (≥22 mL) GTV-E to be an independent unfavorable prognostic factor for LC (hazard ratio [HR], 3.805; 95% CI, 1.100-13.166; P = 0.035).
GTV-E is an independent prognostic factor for LC in T3-4 NPC and may further assist in the optimization of treatment strategies.
本研究旨在探讨原发性肿瘤体积广泛侵犯对接受调强放疗（IMRT）的 T3-4 NPC 患者局部控制的预后价值。
2009 年 1 月至 2015 年 12 月，前瞻性纳入 159 例非转移性 T3-4 NPC 患者，获取 GTV-P、GTV-P 的局限和广泛侵犯部分（GTV-C 和 GTV-E）的初始体积。GTV-E 包括颅骨底部、颈椎、副鼻窦或颅内侵犯的肿瘤。GTV-C 通过从 GTV-P 中减去 GTV-E 计算得出。通过 Kaplan-Meier 方法和多变量分析评估肿瘤体积水平对局部控制率（LC）的影响。
GTV-P（P=0.015）和 GTV-E（P=0.001）与局部失败显著相关，而 GTV-C（P=0.494）则没有。然后通过接受者操作特征曲线分析确定 GTV-P（43mL）和 GTV-E（22mL）的最佳截止值。GTV-E 较小（<22mL）的患者 5 年 LC 率优于 GTV-E 较大（≥22mL）的患者（96.3%比 76.1%，P<0.001），但 GTV-P 较小（<43mL）和较大（≥43mL）的患者之间无显著差异（95.9%比 85.5%，P=0.094）。多变量分析也表明，GTV-E 较大（≥22mL）是 LC 的独立不良预后因素（风险比[HR]，3.805；95%置信区间，1.100-13.166；P=0.035）。
GTV-E 是 T3-4 NPC 局部控制的独立预后因素，可能有助于进一步优化治疗策略。
