Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Eur Arch Otorhinolaryngol. 2021 Jul;278(7):2549-2557. doi: 10.1007/s00405-020-06399-5. Epub 2020 Oct 6.
To evaluate the clinical characteristics and prognosis of elderly nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy (IMRT).
From June 2008 to October 2014, 148 newly diagnosed non-metastatic elderly NPC patients (aged ≥ 70 years) receiving IMRT were recruited. Comorbid condition was evaluated using the age-adjusted Charlson Comorbidity Index (ACCI). Kaplan-Meier method was used to estimate survival rates and the differences were compared using log-rank test. Hazard ratio (HR) and the associated 95% confidence interval (CI) were calculated using Cox proportional hazard model by means of multivariate analysis.
The median follow-up time was 66.35 months. Estimated OS rate at 5 years for the entire group was 61.8% (95% confidence interval [CI] 0.542-0.703). The 5-year OS rate of RT alone group was 58.4% (95% [CI] 0.490-0.696) compared with 65.2% (95% [CI] 0.534-0.796) in CRT group (p = 0.45). In patients receiving IMRT only, ACCI score equal to 3 was correlated with superior 5-year OS rate in comparison with higher ACCI score 62.1% (95% [CI] 0.510-0.766) to 48.5% (95% [CI] 0.341-0.689), respectively; p = 0.024). A 5-year OS rate of 63.1% (95% [CI] 0.537-0.741) was observed in patients younger than 75 years old compared with 57.5% (95% [CI] 0.457-0.723) in patients older (p = 0.026). Patients with early-stage disease (I-II) showed better prognosis than patients with advanced-stage (III-IV) disease (5-year OS, 72.3-55.4%, respectively; p = 0.0073). The Cox proportional hazards model suggested that age independently predicted poorer OS (HR, 1.07; 95%CI 1.00-1.15, p = 0.04).
The survival outcome of patients aged ≥ 70 years receiving IMRT only was similar to chemoradiotherapy with significantly less acute toxicities. Among the population, age is significantly prognostic for survival outcomes.
评估接受调强放疗（IMRT）的老年鼻咽癌（NPC）患者的临床特征和预后。
自 2008 年 6 月至 2014 年 10 月，共招募了 148 例新诊断的非转移性老年 NPC 患者（年龄≥70 岁）接受 IMRT。合并症采用年龄调整 Charlson 合并症指数（ACCI）进行评估。采用 Kaplan-Meier 法估计生存率，采用对数秩检验比较差异。采用 Cox 比例风险模型通过多因素分析计算危险比（HR）及其 95%置信区间（CI）。
中位随访时间为 66.35 个月。全组 5 年 OS 率估计为 61.8%（95%CI 0.542-0.703）。单纯放疗组的 5 年 OS 率为 58.4%（95%CI 0.490-0.696），与 CRT 组的 65.2%（95%CI 0.534-0.796）相比无显著差异（p=0.45）。仅接受 IMRT 的患者中，ACCI 评分为 3 分与 5 年 OS 率较高相关，而 ACCI 评分为 6 分的患者 5 年 OS 率为 62.1%（95%CI 0.510-0.766），评分更高的患者为 48.5%（95%CI 0.341-0.689）；p=0.024）。年龄小于 75 岁的患者 5 年 OS 率为 63.1%（95%CI 0.537-0.741），年龄较大的患者为 57.5%（95%CI 0.457-0.723）（p=0.026）。早期（I-II）疾病患者的预后优于晚期（III-IV）疾病患者（5 年 OS 率分别为 72.3%和 55.4%；p=0.0073）。Cox 比例风险模型表明，年龄独立预测较差的 OS（HR，1.07；95%CI 1.00-1.15，p=0.04）。
仅接受调强放疗的年龄≥70 岁患者的生存结果与放化疗相似，但急性毒性明显较少。在人群中，年龄对生存结果具有显著的预后意义。
