老年鼻咽癌患者调强放疗后的急性毒性反应及预后：列线图预测
Acute Toxicities and Prognosis of Elderly Patients with Nasopharyngeal Carcinoma After Intensity-Modulated Radiotherapy: Prediction with Nomogram.
作者信息
Liang Yu, Chen Kai-Hua, Yang Jie, Zhang Jing, Peng Ru-Rong, Qu Song, Li Ling, Zhu Xiao-Dong
机构信息
Affiliated Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China.
Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People's Republic of China.
出版信息
Cancer Manag Res. 2020 Sep 22;12:8821-8832. doi: 10.2147/CMAR.S261717. eCollection 2020.
PURPOSE
To explore acute toxicities and prognosis of elderly NPC patients after IMRT; to identify predictors regarding age, chemotherapy, comorbidities, nutrition status, and psychological condition; and to establish a nomogram for the prediction of prognosis.
PATIENTS AND METHODS
Elderly NPC patients were divided into three groups (age of 60-65, age of 66-70, and age over 70) and were retrospectively analyzed. The acute toxicities, prognosis, and potential predictors were analyzed. Then, a nomogram for PFS was established, and the performance of nomogram was compared with the performance of TNM system.
RESULTS
A total of 214 elderly patients (214/1981, 10.8%) were involved. Patients of Stage III and IV accounted for 73.4%. The 3-year, 5-year PFS and OS were 77.9%, 66.3%, 79.3% and 66.8%, respectively. Elder patients had a worse prognosis (=0.002). The main cause of death remained in recurrence and metastasis; few died from comorbidities, and some died from nutrition status and psychological condition. Age (HR=1.10, 95% CI=1.05-1.15, <0.001), ALB level (HR=0.93, 95% CI=0.88-0.99, =0.019), and T stage (HR=1.85, 95% CI=1.10-3.13, =0.022) were critical for PFS, but chemotherapy or comorbidities were not. Acute toxicities were mainly at or under grade II. N stage (OR=2.50, 95% CI=1.28-4.88, =0.007) and chemotherapy (OR=6.01, 95% CI=3.11-11.63, <0.001) were risk factors for hematological toxicity; while age (OR=0.59, 95% CI=0.37-0.92, =0.020) and chemotherapy (OR=225.14, 95% CI=61.91-818.64, <0.001) influenced emesis; ALB (OR=1.11, 95% CI=1.04-1.19, =0.002) affected mucositis. Comorbidities were not influential in acute toxicities. The nomogram for PFS (C-index=0.682, 95% CI=0.617-0.747) performed better than the TNM system (C-index=0.604, 95% CI=0.532-0.674, <0.001).
CONCLUSION
Elderly NPC patients sustained poor prognosis. The easily applied nomogram is hopeful to benefit the clinical decision-making.
目的
探讨老年鼻咽癌患者调强放疗后的急性毒性反应及预后；确定年龄、化疗、合并症、营养状况和心理状态等预测因素；并建立预后预测列线图。
患者与方法
将老年鼻咽癌患者分为三组（60 - 65岁、66 - 70岁和70岁以上）并进行回顾性分析。分析急性毒性反应、预后及潜在预测因素。然后建立无进展生存期（PFS）列线图，并将列线图的性能与TNM系统的性能进行比较。
结果
共纳入214例老年患者（214/1981，10.8%）。Ⅲ期和Ⅳ期患者占73.4%。3年、5年PFS和总生存期（OS）分别为77.9%、66.3%、79.3%和66.8%。老年患者预后较差（P = 0.002）。主要死亡原因仍为复发和转移；少数死于合并症，部分死于营养状况和心理状态。年龄（HR = 1.10，95%CI = 1.05 - 1.15，P < 0.001）、白蛋白（ALB）水平（HR = 0.93，95%CI = 0.88 - 0.99，P = 0.019）和T分期（HR = 1.85，95%CI = 1.10 - 3.13，P = 0.022）对PFS至关重要，但化疗或合并症并非如此。急性毒性反应主要为Ⅱ级及以下。N分期（OR = 2.50，95%CI = 1.28 - 4.88，P = 0.007）和化疗（OR = 6.01，95%CI = 3.11 - 11.63，P < 0.001）是血液学毒性的危险因素；而年龄（OR = 0.59，95%CI = 0.37 - 0.92，P = 0.020）和化疗（OR = 225.14，95%CI = 61.91 - 818.64，P < 0.001）影响呕吐；ALB（OR = 1.11，95%CI = 1.04 - 1.19，P = 0.002）影响口腔黏膜炎。合并症对急性毒性反应无影响。PFS列线图（C指数 = 0.682，95%CI = 0.617 - 0.747）的性能优于TNM系统（C指数 = 0.604，95%CI = 0.532 - 0.6
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