【摘要】 目的:回顾性分析我院采用调强放疗(intensity-modulated radiotherapy, IMRT)治疗鼻咽癌的疗效及预后影响因素。方法:收集2009年01月至2015年08月691例鼻咽癌患者的临床资料进行生存分析。结果:中位随访时间为62.8个月,全组患者5年总生存(overall survival, OS)、肿瘤特异生存(disease-special survival, DSS)、无进展生存(progression free survival, PFS)、局部区域无复发生存(locoregional recurrence free survival, LRFS)、无远处转移生存(distant metatasisfree survival, DMFS)率分别为85.8%、86.5%、82.5%、90.7%和89.4%。Ⅰ、Ⅱ、Ⅲ、Ⅳ_a期患者5年LRFS和DMFS分别为100.0%和100.0%、99.2%和96.0%、93.5%和92.7%、83.4%和76.1%。共109例患者死亡,其中102例死于肿瘤,7例死于非肿瘤。63例患者复发,44例(70.0%)3年内出现复发,仅6例(9.5%)超过5年复发。72例患者发生转移,63例(87.5%)3年内出现转移,仅1例(1.4%)超过5年转移。性别、T和N分期是影响OS、DSS、PFS、LRFS、DMFS的独立预后因素。诱导化疗与未行诱导化疗对比,Ⅲ期和Ⅳ_a期患者5年DSS分别为95.8%∶89.3%(P<0.05)和73.1%∶68.9%(P<0.05);同期化疗与未行同期化疗对比,Ⅲ期和Ⅳ_a期患者5年DSS分别为92.8%∶85.5%(P<0.05)和72.7%∶53.0%(P<0.05)。结论:鼻咽癌患者采用IMRT治疗后取得较长时间的生存,复发或转移主要发生在放疗结束后2～3年内,诱导化疗和同期化疗能改善局部晚期鼻咽癌患者的5年DSS。更多还原

【Abstract】 Objective:To retrospectively analyze the survival outcome and prognostic factors for patients with nasopharyngeal carcinoma(NPC) receiving intensity-modulated radiotherapy(IMRT).Methods:Clinical data of 691 patients with NPC receiving IMRT from January 2009 to August 2015 were collected.Survival analysis and prognostic factors were performed and analyzed.Results:The median follow-up time was 62.8 months.The 5-year overall survival rate(OS),disease-special survival rate(DSS),progression-free survival rate(PFS),locoregional recurrence free survival rate(LRFS) and distant metastasis free survival rate(DMFS) were 85.8%,86.5%,82.5%,90.7% and 89.4%,respectively.The 5-year LRFS and DMFS of phase Ⅰ,Ⅱ,Ⅲ and Ⅳ_a were 100.0% and 100.0%,99.2% and 96.0%,93.5% and 92.7%,83.4% and 76.1%,respectively.A total of 109 patients died(102 died of tumor and 7 died of non-tumor).63 patients experienced relapse, 44 cases(70.0%) occurred within 3 years, and only 6 cases(9.5%) occurred over 5 years.72 cases metastasized, 63 cases(87.5%) occurred within 3 years, and only 1 case(1.4%) occurred over 5 years.Gender, T stage and N stage were the prognostic factors of OS,DSS,PFS,LRFS and DMFS.Patients with or without induction chemotherapy had 5-year DSS of 95.8% vs 89.3%(P<0.05) and 92.8% vs 85.5%(P<0.05) in stage Ⅲ and Ⅳ_a NPC.While the 5-year DSS of patients with or without concurrent chemotherapy in stage Ⅲ and Ⅳ_a NPC were 73.1% vs 68.9%(P<0.05) and 72.7% vs 53.0%(P<0.05).Conclusion:IMRT improves the survival rate of NPC patients.Recurrence or metastasis mainly occurs within 2 to 3 years after radiotherapy.Induction and concurrent chemotherapy improve the 5-year DSS of patients with locally advanced NPC.更多还原