放射治疗对转移性鼻咽癌生存的影响——基于SEER数据库的回顾性研究

目的 探讨放疗对转移性鼻咽癌(NPC)患者生存的影响及其相关预后因素分析。方法 利用SEER数据库搜索并筛选2010-2015年初诊为转移性NPC患者329例,回顾分析329例患者的病历资料(199例接受放疗,130例未接受放疗)。采用Kaplan-Meier曲线计算总生存(OS)及疾病特异性生存(DSS),采用Logrank检验及Cox回归分析评估不同临床病理因素对转移性NPC患者预后影响。结果 中位随访时间为12个月,3、5年OS率分别为27.4%、19.7%,中位OS期17.9个月。单因素分析结果显示,年龄<50岁、男性、病理未分化型、T3或T4分期、区域淋巴结阳性、脑或肝转移、转移脏器个数1~2个的患者放疗3年后OS及DSS获益。采用倾向得分匹配后单因素及多因素回归分析结果显示,放疗是转移性NPC的独立预后影响因素(OS,P=0.004;DSS,P=0.014)。多因素回归分析结果还显示,60~69岁(OS,P=0.033;DSS,P=0.045)、角化性鳞状细胞癌(OS,P<0.05;DSS,P<0.050)、T4期(OS,P=0.002;DSS,P=0.024)、1~2个(OS,P=0.039;DSS,P=0.058)及3~4个(OS,P=0.003;DSS,P=0.005)脏器转移、未接受化疗(OS,P=0.000;DSS,P=0.000)的患者预后差,而性别、人种、分化程度对OS及DSS无影响。结论 放疗可显著改善转移性NPC患者的OS及DSS。放疗在转移性NPC治疗中的作用机制还需前瞻性随机对照研究进一步明确。

Survival benefit of radiotherapy for metastatic nasopharyngeal carcinoma:a retrospective analysis based on SEER database

Objective To analyze survival benefits of radiotherapy in patients with nasopharyngeal carcinoma (NPC) with distant metastases and analyze relevant prognostic factors. Methods Medical records of 329 patients newly diagnosed with metastatic NPC screened from the Surveillance, Epidemiology and End Results (SEER) database (199 of 329 patients received radiotherapy) between 2010 and 2015 were retrospectively analyzed. Overall survival (OS) and disease-specific survival (DSS) were calculated by Kaplan-Meier curve. The effect of different clinicopathological factors on the clinical prognosis of metastatic NPC patients was evaluated by logrank test and Cox regression analysis. Results The median follow-up time was 12 months. The 3-and 5-year OS rates were 27.4% and 19.7%. The median OS was 17.9 months. Univariate analysis demonstrated that patients aged< 50 years, male, undifferentiated type, stage T3 or T4, positive regional lymph node, brain and liver metastases and 1-2 metastatic sites obtained OS and DSS benefits at 3 years after radiotherapy. Univariate and multivariate Cox analyses after propensity score matching showed that radiotherapy was an independent prognostic factor for metastatic NPC (OS,P=0.004;DSS,P=0.014). Besides, patients aged 60-69 years (OS,P=0.033;DSS,P=0.045), keratinizing squamous cell carcinoma (OS,P<0.05;DSS,P<0.05), stage T4(OS,P=0.002;DSS,P=0.024),1-2 metastatic sites (OS,P=0.039;DSS,P=0.058),3-4 metastatic sites (OS,P=0.003;DSS,P=0.005) and no chemotherapy (OS,P=0.000;DSS,P=0.000) had poor OS and DSS, whereas sex, race and degree of differentiation exerted no effect on OS and DSS. Conclusions Radiotherapy can significantly improve the OS and DSS of patients with metastatic NPC. Prospective and randomized controlled studies are required to further explore the role of radiotherapy in the management of metastatic NPC.