鼻咽癌T3N0-1M0期单纯放疗和同期放化疗疗效回顾分析

 目的　回顾分析T3N0~1M0期鼻咽癌患者临床资料，探讨单纯放射治疗与同期放化疗两种治疗方式与预后的关系。方法　中山大学肿瘤防治中心2004年1月至12月收治的经病理学证实的初治鼻咽癌患者781例，均有完整鼻咽和颈部MRI资料，且均无远处转移。按照2008中国鼻咽癌分期标准重新分期，82例行单纯放疗或同期放化疗的T3N0~1M0期患者入组，分为单纯放疗（A组）46例，同时期放化疗（B组）36例。结果　两组患者的临床资料具有可比性，单因素分析显示A组和B组的5年总生存（OS）率分别为93.5 %和100 %（P＝0.046），5年无瘤生存（DFS）率分别为85.2 %和91.7 %（P＝0.498）。N分期是鼻咽癌DFS的影响因素（P＝0.026）。分层分析显示：T3N0M0期患者A组和B组5年OS率分别为94.7 %和100 %（P＝0.432）；T3N1M0期A组和B组5年OS率分别为92.6 %和100 %（P＝0.066）；T3N1M0期A组和B组5年DFS率分别为73.7 %和89.3 %（P＝0.244）。多因素分析显示，同期放化疗不是 T3N0~1M0期鼻咽癌患者OS的独立预后因素（HR＝0.019；95 % CI 0～21.793），N分期不是影响T3N0~1M0期鼻咽癌患者DFS的独立预后因素（HR＝0.203；95 % CI 0.135～1.231×104）。结论　T3N0M0期患者同期放化疗与单纯放疗疗效无差异， T3N1M0期患者行同期放化疗能否改善生存有待进一步研究。

Retrospective analysis of efficacy on radiotherapy alone and concurrent chemoradiotherapy for patients with stage T3N0-1M0 nasopharyngeal cancer

Objective To retrospectively analyze the data of patients with T3N0-1M0 nasopharyngeal carcinoma (NPC) who underwent radiotherapy (RT) alone or concurrent chemoradiotherapy (CCRT), and to investigate the relationship between therapeutic modality and prognosis. Methods From January 2004 to December 2004, 781 patients with biopsy-proven newly diagnosed non-metastatic NPC were analyzed in Sun Yat-Sen University Cancer Center, who had MRI data of nasopharynx and neck. With restaged based on the Chinese 2008 staging system, 82 cases of T3N0-1M0 patients who were treated by RT alone or CCRT were enrolled. They were divided into group A (46 cases, RT) and group B (36 cases, CCRT). Results The clinical data was comparable between the two groups. The 5-year overall survival rate (OS) was 93.5 % (group A) and 100 % (group B)(P =0.046), while the 5-year disease-free survival rate (DFS) was 85.2 % (group A) and 91.7 % (group B) (P =0.498). N-Staging was the factor affecting the DFS. Stratified analysis showed that the 5-year OS of T3N0M0 patients was 94.7 % (group A) and 100 % (group B) (P =0.432), those of T3N1M0 patients were 92.6 %(group A) and 100 %(group B) (P =0.066), while the 5-year DFS was 73.7 % (group A) and 89.3 % (group B) (P =0.244). Multifactor analysis showed that CCRT was not the independent factor affecting the OS(HR =0.019; 95 % CI, 0 to 21.793), and N-stage was not the independent factor affecting the DFS (HR = 0.203; 95 % CI, 0.135 to 1.231×104). Conclusion For T3N0M0, NPC patients, CCRT is not superior to RT alone. Whether CCRT can improve survival of T3N1M0 NPC patients needs further study.