摘要
目的评价同步放化疗(concurrent chemoradiotherapy,CCRT)联合辅助化疗(adjuvant chemotherapy,AC)对局部晚期鼻咽癌(nasopharyngeal carcinoma,NPC)的临床疗效。方法纳入2011年4月至2019年1月在陆军军医大学第二附属医院肿瘤放疗中心初治的局部晚期NPC患者318例,根据CCRT后是否行辅助化疗分为辅助组(n=202)和未辅助组(n=116),对比分析辅助化疗对局部晚期NPC患者的生存结局和不良反应。分层比较318例患者不同治疗方案[CCRT与CCRT+AC、诱导化疗(induction chemotherapy,IC)+CCRT与IC+CCRT+AC]的生存差异,分析辅助组与未辅助组配对后的99对患者在各临床指标亚组的生存差异。结果与单纯CCRT相比,CCRT联合辅助化疗有提高总生存时间(overall survival,OS)、无进展生存时间(progression-free survival,PFS)、无远处转移生存时间(distant metastasis-free survival,DMFS)、无复发生存时间(recurrence-free survival,RFS)的趋势;与IC+CCRT相比,辅助化疗(IC+CCRT+AC)有降低OS、PFS、DMFS、RFS的趋势。分层结果显示,辅助化疗有提高EBV阳性、N_(3)期、ⅣA期患者OS、PFS、DMFS、RFS的趋势,有提高T_(4)期RFS的趋势;两组患者在急性放射性黏膜炎、急性放射性咽炎和食管炎的发生上无差异;辅助组2级以上骨髓抑制发生率高于未辅助组(68%vs 55%,P=0.020)。结论局部晚期NPC同步放化疗后的辅助化疗未显著增加生存获益,但对于EBV阳性、N_(3)期、ⅣA期患者的OS、PFS、DMFS、RFS有获益趋势,对于T_(4)期患者有RFS获益趋势。
Objective To evaluate the clinical efficacy of the concurrent chemoradiotherapy(CCRT)combined adjuvant chemotherapy(AC)for locally advanced nasopharyngeal carcinoma(NPC).Methods From April 2011 to January 2019,318 patients with locally advanced NPC were collected from radiotherapy center of the Second Affiliated Hospital of Army Medical University.According to the results of CCRT,the patients were divided into the adjuvant group and the no-adjuvant group to comparatively analyze the survival outcome and adverse reaction of those patients received adjuvant chemotherapy.Stratification analysis was used to analyze the survival difference of different therapy plans(CCRT,CCRT+AC,IC+CCRT and IC+CCRT+AC)among 318 patients.The survival difference of 99 pairs of patients in the subgroup of clinical parameters was analyzed after the patients in the adjuvant group were paired with the patients in the no-adjuvant group.Results Compared with CCRT,CCRT combined with adjuvant chemotherapy could increase the overall survival(OS),progression-free survival(PFS),distant metastasis-free survival(DMFS)and recurrence-free survival(RFS);Compared with IC plus CCRT(IC+CCRT),IC+CCRT+AC showed a decreasing trend in OS,PFS,DMFS and RFS.According to the results of stratification analysis,for EBV positive,N_(3)stage and IVA stage patients,adjuvant chemotherapy had a tendency to increase OS,PFS,DMFS and RFS,and increase the RFS for the T_(4)stage patients.There was no difference in acute radiation mucositis,acute radiation pharyngitis and esophagitis between the two groups.The adjuvant group had higher incidence rate than the non-adjuvant group in≥2 grade of myelosuppression(68%vs 55%,P=0.020).Conclusion Adjuvant chemotherapy after concurrent chemoradiotherapy cannot significantly increase the survival benefit for patients with locally advanced NPC;For EBV positive,stage N_(3)and stageⅣA patients,there is a positive trend in OS,PFS,DMFS and RFS,and for stage T_(4)patients,they also obtain benefit in PFS.
作者
杨秀
杨峤
陈光朋
张岸梅
崔天祥
钟良志
孙建国
YANG Xiu;YANG Qiao;CHEN Guangpeng;ZHANG Anmei;CUI Tianxiang;ZHONG Liangzhi;SUN Jianguo(Department of Oncology,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037;Department of Ultrasound Diagnosis,NO.941 Hospital of the PLA Joint Logistic Support Force,Xining,Qinghai Province,810007,China)
出处
《陆军军医大学学报》
CAS
CSCD
北大核心
2022年第22期2307-2316,共10页
Journal of Army Medical University
基金
国家自然科学基金面上项目(81972858)
重庆市科技创新领军人才支持计划(cstccx1jrc201910)
关键词
鼻咽癌
同步放化疗
辅助化疗
生存结局
不良反应
nasopharyngeal carcinoma
concurrent chemoradiotherapy
adjuvant chemotherapy
survival outcome
adverse events
