Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai 201321, China; Shanghai Key Laboratory of Radiation Oncology（20dz2261000, Shanghai 201321, China; Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai 201321, China.
Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai 201321, China; Shanghai Key Laboratory of Radiation Oncology（20dz2261000, Shanghai 201321, China; Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai 201321, China.
Oral Oncol. 2024 Apr;151:106683. doi: 10.1016/j.oraloncology.2024.106683. Epub 2024 Feb 22.
Although carbon ion radiation therapy (CIRT) substantially improves the overall survival (OS) of patients with LR-NPC, approximately 40% of the patients may develop local recurrence. The purpose of study is to assess the value of tumor volume (TV) as a predictive tool to guide individualized CIRT.
Consecutive patients with LR-NPC treated using CIRT at Shanghai Proton and Heavy Ion Center between April 2015 and May 2019 were included. TV before CIRT was delineated and calculated. The generalized additive Cox model was used to examine the relationship between TV and OS and local progression-free survival (LPFS). A cutoff value of tumor volume was identified to best discriminate patients with different 2-year OS rates, using receiver operating characteristic (ROC) analysis.
A total of 157 patients were enrolled. The median tumor volume was 22.49 (2.52-90.13) ml. In the univariable analyses, tumor volume was significantly associated with OS (p < 0.001) and LPFS (p = 0.01). The relationships with OS (p = 0.009) and LPFS (p = 0.020) remained significant in multivariable analyses. Using ROC analysis, a TV of 26.69 ml was identified to predict the 2-year OS rate. To facilitate potential clinical use, 25 ml was designated as the final cutoff value. The 2-year OS and LPFS rates were 88.6 % vs 62.3 %, and 54.7 % vs 35.5 %, for patients with a TV ≤ 25 ml and > 25 ml, respectively.
Tumor volume could predict the OS and LPFS of patients. We propose that tumor volume should be considered in the risk stratification and CIRT-based treatment for patients with LR-NPC.
尽管碳离子放射治疗（CIRT）显著提高了局部晚期鼻咽癌（LR-NPC）患者的总生存率（OS），但约 40%的患者可能会出现局部复发。本研究旨在评估肿瘤体积（TV）作为预测工具指导个体化 CIRT 的价值。
纳入 2015 年 4 月至 2019 年 5 月在上海质子重离子医院接受 CIRT 治疗的连续 LR-NPC 患者。在 CIRT 前对 TV 进行勾画和计算。采用广义加性 Cox 模型研究 TV 与 OS 和局部无进展生存率（LPFS）之间的关系。采用接受者操作特征（ROC）分析确定肿瘤体积的最佳截断值，以区分 2 年 OS 率不同的患者。
共纳入 157 例患者。中位肿瘤体积为 22.49（2.52-90.13）ml。单变量分析中，肿瘤体积与 OS（p<0.001）和 LPFS（p=0.01）显著相关。多变量分析中，肿瘤体积与 OS（p=0.009）和 LPFS（p=0.02）仍显著相关。ROC 分析确定 TV 为 26.69ml 预测 2 年 OS 率。为便于潜在的临床应用，将 25ml 定为最终截断值。TV≤25ml 和>25ml 的患者 2 年 OS 和 LPFS 率分别为 88.6%和 62.3%，54.7%和 35.5%。
肿瘤体积可预测患者的 OS 和 LPFS。我们提出，肿瘤体积应在 LR-NPC 患者的风险分层和基于 CIRT 的治疗中加以考虑。
