【摘要】 目的探讨肿瘤体积(GTV)对局部晚期鼻咽癌患者预后的影响。方法分析310例接受放化疗的Ⅲ～ⅣA/B期鼻咽癌患者的临床资料及随访资料,以受试者工作特征(ROC)曲线确定治疗前GTV最佳界值为34.1 mL,选取GTV> 34.1 mL患者106例纳入实验组,依据年龄、性别、卡氏功能状态量表(KPS)评分、T分期、N分期、临床分期采用倾向值匹配法,获得106例(1∶1匹配) GTV≤34.1 mL患者纳入对照组。采用Kaplan-Meier法计算生存率,以Cox回归模型进行预后因素分析。主要研究终点为无局部-区域进展生存率(LRRFS),次要研究终点为总生存率(OS)和无远处转移生存率(DMFS)。结果实验组4年LRRFS(80.2%)低于对照组(92.5%),4年OS(77.4%)低于对照组(84.0%),差异有统计学意义(P=0.008、0.043);实验组与对照组4年DMFS分别为68.9%、74.5%,差异无统计学意义(P=0.273); Cox回归模型显示,GTV> 34.1 mL是LRRFS和OS的不良影响因素。结论 GTV> 34.1 mL是局部晚期鼻咽癌患者局部-区域进展和死亡的不良影响因素,对此类患者需增大治疗强度,以获得更好的临床疗效。更多还原

【Abstract】 Objective To evaluate the primary gross tumor volume (GTV) on prognosis in patients with local advanced nasopharyngeal carcinoma. Methods The clinical data and follow-up data of 310 patients with nasopharyngeal carcinoma in Ⅲ to IVA/B phase undergoing chemoradiotherapy were retrospectively analyzed. The optimized critical value of GTV was confirmed as 34. 1 mL by Receiver Operating Characteristic (ROC) curve analysis. A total of 106 cases with GTV > 34. 1 mL were included in the experimental group. Propensity matched study method was used to adjust for age,gender,Karnofsky Performance Status (KPS),tumor stage,node stage,and clinical stage. At last,a well-balanced cohort (106 cases who had GTV of less or equaling to 34. 1 mL) was created by 1∶ 1 matching in the control group. Survival rate was calculated using Kaplan-Meier method,and prognostic factors were analyzed using Cox regression model. The primary end-point was loco-regional relapse-free survival rate (LRRFS),secondary end-points were overall survival (OS) and distant metastasis-free survival (DMFS). Results The experimental group had lower 4-year LRRFS and OS when compared to the control group (80. 2% versus 92. 5%,77. 4% versus 84. 0%,P = 0. 008,0. 043). The 4-year DMFS of the experimental group and the control group were 68. 9% and 74. 5%,respectively,but no significant difference was found (P = 0. 273). Cox regression model showed that GTV > 34. 1 mL was an adverse influencing factor of LRRFS and OS. Conclusion GTV > 34. 1 mL is an adverse influencing factor for loco-regional progress and death in local advanced nasopharyngeal carcinoma. It is necessary to increase the treatment intensity in order to obtain better clinical efficacy.更多还原