摘要
目的探讨鼻咽癌患者放疗过程中肿瘤退缩速度与预后的关系。方法接受根治性放疗的753例鼻咽癌患者,原发肿瘤和转移淋巴结的体外照射处方剂量为65～70Gy,颈部预防剂量50～55Gy。≤50Gy完全退缩的定义为快速退缩,>50Gy～≤70Gy完全退缩的定义为缓慢退缩,其余的定义为残留。采用KaplanMeier法进行生存分析,差异用Logrank检验,对可能影响预后的因素运用Cox回归模型分析。结果快速退缩、缓慢退缩、残留的5年生存率分别为64.6%、72.5%和49.7%(χ2=8.92,P=0.004),无病生存率分别为60.2%、71.8%和29.4%(χ2=9.75,P=0.002),无远地转移生存率分别为70.8%、80.3%和55.1%(χ2=10.36,P=0.001),无局部区域失败生存率分别为88.0%、88.4%和65.9%(χ2=9.81,P=0.001)。多因素分析发现肿瘤退缩速度、T分期、N分期对预后有明显影响,而性别与年龄不是预后相关因素。结论根治性放疗过程中肿瘤退缩速度明显影响鼻咽癌患者的5年生存率、无病生存率、无远地转移生存率、无局部区域失败生存率。缓慢退缩的预后最好,快速退缩的其次,残留的最差。
Objective To evaluate the prognostic value of tumor regression speed during radiation therapy for nasopharyngeal carcinoma (NPC). Methods Between January 1993 and December 1995, 753 NPC patients received radical radiotherapy in Cancer Hospital, Shanghai, China. The prescribed external radiation dose was 65-70?Gy to the primary tumor and positive neck nodes, 50-55?Gy to the clinically negative neck. The size of the primary lesion was evaluated weekly by endoscopy during the entire course of radiotherapy. Rapid regression was defined as a complete response before 50?Gy, slow regression in the range of 50-70?Gy and the other conditions were defined as residual disease. Survival rates were calculated by Kaplan-Meier method, differences among which were tested by Logrank method. Potentially significant parameters were analyzed by Cox regression method. Results In the rapid, slow regression and residual groups, the overall survival rates were 64.6%,72.5% and 49.7%(χ2=8.92,P=0.004). The 5-year disease-free survival rates were 60.2%,71.8%and 29.4%(χ2=~9.75 ,P=0.002). The 5-year distant metastasis-free survival rates were 70.8%,80.3%and 55.1%(χ2=~10.36 , P=0.001) and the 5-year local regional failure-free survival rates were 88.0%,88.4% and 65.9%, respectively (χ2=9.81, P=0.001). Tumor regression rate and T,N Stage were the significant prognostic factors of survival in multivariate analysis, but age and gender were not. Conclusions Tumor regression rate during radical radiotherapy has significant predictive value on 5-year overall survival, disease-free survival, distant metastasis-free survival and locoregional failure-free survival. Slow response suggests the best prognosis, followed by rapid regression. Residual disease suggests the worst survival.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2005年第1期6-9,共4页
Chinese Journal of Radiation Oncology
关键词
鼻咽癌
肿瘤退缩速度
放射疗法
淋巴结转移
Nasopharyngeal neoplasms/radiotherapy
Tumor regression speed
Prognosis
