Prognostic factors and failure patterns in non-metastatic nasopharyngeal carcinoma after intensity-modulated radiotherapy

Background:The prognostic values of staging parameters require continual re?assessment amid changes in diag?nostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of non?meta?static nasopharyngeal carcinoma (NPC) in the intensity?modulated radiotherapy (IMRT) era. Methods:We reviewed the data from 749 patients with newly diagnosed, biopsy?proven, non?metastatic NPC in our cancer center (South China, an NPC endemic area) between January 2003 and December 2007. All patients under?went magnetic resonance imaging (MRI) before receiving IMRT. The actuarial survival rates were estimated using the Kaplan–Meier method, and survival curves were compared using the log?rank test. Multivariate analyses with the Cox proportional hazards model were used to test for the independent prognostic factors by backward eliminating insigniifcant explanatory variables. Results:The 5?year occurrence rates of local failure, regional failure, locoregional failure, and distant failure were 5.4, 3.0, 7.4, and 17.4%, respectively. The 5?year survival rates were as follows: local relapse?free survival, 94.6%; nodal relapse?free survival, 97.0%; distant metastasis?free survival, 82.6%; disease?free survival, 75.1%; and overall survival, 82.0%. Multivariate Cox regression analysis revealed that orbit involvement was the only signiifcant prognostic fac?tor for local failure (P=0.011). Parapharyngeal tumor extension, retropharyngeal lymph node involvement, and the laterality, longest diameter, and Ho’s location of the cervical lymph nodes were signiifcant prognostic factors for both distant failure and disease failure (allP<0.05). Intracranial extension had signiifcant prognostic value for distant failure (P=0.040). Conclusions:The key failure pattern for NPC was distant metastasis in the IMRT era. With changes in diagnostic and therapeutic technologies as well as treatment modalities, the signiifcant prognostic parameters for local control have also been altered substantially.     

Prognostic value and predictive threshold of tumor volume for patients with locally advanced nasopharyngeal carcinoma receiving intensity-modulated radiotherapy

Background:Gross target volume of primary tumor (GTV?P) is very important for the prognosis prediction of patients with nasopharyngeal carcinoma (NPC), but it is unknown whether the same is true for locally advanced NPC patients treated with intensity?modulated radiotherapy (IMRT). This study aimed to clarify the prognostic value of tumor volume for patient with locally advanced NPC receiving IMRT and to ifnd a suitable cut?off value of GTV?P for prognosis prediction. Methods:Clinical data of 358 patients with locally advanced NPC who received IMRT were reviewed. Receiver oper?ating characteristic (ROC) curves were used to identify the cut?off values of GTV?P for the prediction of different end?points [overall survival (OS), local relapse?free survival (LRFS), distant metastasis?free survival (DMFS), and disease?free survival (DFS)] and to test the prognostic value of GTV?P when compared with that of the American Joint Committee on Cancer T staging system. Results:The 358 patients with locally advanced NPC were divided into two groups by the cut?off value of GTV?P as determined using ROC curves: 219 (61.2%) patients with GTV?P≤46.4mL and 139 (38.8%) with GTV?P>46.4mL. The 3?year OS, LRFS, DMFS, and DFS rates were all higher in patients with GTV?P≤46.4mL than in those with GTV?P>46.4mL (allP<0.05). Multivariate analysis indicated that GTV?P>46.4mL was an independent unfavorable prognostic factor for patient survival. The ROC curve veriifed that the predictive ability of GTV?P was superior to that of T category (P<0.001). The cut?off values of GTV?P for the prediction of OS, LRFS, DMFS, and DFS were 46.4, 57.9, 75.4 and 46.4mL, respectively. Conclusion:In patients with locally advanced NPC, GTV?P>46.4mL is an independent unfavorable prognostic indi?cator for survival after IMRT, with a prognostic value superior to that of T category.     

鼻咽癌调强放疗疗效及预后影响因素分析(附691例)

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...     

Treatment outcomes for different subgroups of nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy

Although many studies have investigated intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC), sample sizes in the reported studies are usually small and different in outcomes in different T and N subgroups are seldom analyzed. Herein, we evaluated the outcomes of NPC patients treated with IMRT and further explored treatment strategy to improve such outcome. We collected clinical data of 865 NPC patients treated with IMRT alone or in combination with chemotherapy, and classified all cases into the following prognostic categories according to different TNM stages: early stage group (T1-2N0-1M0), advanced local disease group (T3-4N0-1M0), advanced nodal disease group (T1-2N2-3M0), and advanced locoregional disease group (T3-4N2-3M0). The 5-year overall survival (OS), local relapse-free survival (LRFS), and distant metastases-free survival (DMFS) were 83.0%, 90.4%, and 84.0%, respectively. The early disease group had the lowest treatment failure rate, with a 5-year OS of 95.6%. The advanced local disease group and advanced nodal disease group had similar failure pattern and treatment outcomes as well as similar hazard ratios for death (4.230 and 4.625, respectively). The advanced locoregional disease group had the highest incidence of relapse and death, with a 5-year DMFS and OS of 62.3% and 62.2%, respectively, and a hazard ratio for death of 10.402. Comparing with IMRT alone, IMRT in combination with chemotherapy provided no significant benefit to locoregionally advanced NPC. Our results suggest that the decision of treatment strategy for NPC patients should consider combinations of T and N stages, and that IMRT alone for early stage NPC patients can produce satisfactory results. However, for advanced local, nodal, and locoregional disease groups, a combination of chemotherapy and radiotherapy is recommended.     

鼻咽癌IMRT后腮腺区域失败分析

目的 讨论鼻咽癌IMRT后腮腺复发的潜在原因。方法 回顾我院2005—2012年间鼻咽癌IMRT患者 1096例,其中腮腺复发 13例,可分析腮腺复发 12例。以腮腺复发侧为病例组、腮腺健侧为对照组进行病例对照研究。分析腮腺失败与肿瘤侵犯范围、IMRT剂量分布、局部复发等因素之间关系。组间比较行χ²检验或Fisher′s精确概率法检验。结果 11例患者原发鼻咽癌为Ⅲ—Ⅳ期,根治性IMRT后 9例有局部区域残留。腮腺复发中位时间为16(8~43)个月。腮腺复发患者中 8例位于腮腺浅叶、1例位于深叶,另外 3例累及腮腺深、浅叶。腮腺复发见于原发肿瘤中心同侧(P=0.000)。腮腺复发侧颈部穿刺和(或)手术史较健侧多见(P=0.025)。腮腺复发多合并同侧颈淋巴结复发(67%∶8%,P=0.003),并有合并同侧原发灶复发的趋势(42%∶8%,P=0.059)。结论 鼻咽癌IMRT后腮腺复发率很低。腮腺复发可能与鼻咽癌局部晚期、治疗后残留、颈部穿刺和(或)手术史,以及局部区域复发有关。IMRT导致腮腺区放疗低剂量可能是腮腺复发的重要原因。     

T-category Remains an Important Prognostic Factor for Oropharyngeal Carcinoma in the Era of Human Papillomavirus

AimsTo determine prognostic factors for locoregional relapse (LRR), distant relapse and all-cause death in a contemporary cohort of locoregionally advanced oropharyngeal squamous cell carcinoma (OSCC) treated with definitive chemoradiotherapy or radiotherapy alone.Materials and methodsOSCC patients treated with definitive radiotherapy between 2005 and 2010 were identified from a prospective head and neck database. Patient age, gender, smoking history, human papillomavirus (HPV) status, T- and N-category, lowest involved nodal level and gross tumour volume of the primary (GTV-p) and nodal (GTV-n) disease were analysed in relation to LRR, distant relapse and death by way of univariate and multivariate analysis.ResultsIn total, 130 patients were identified, 88 HPV positive, with a median follow-up of 42 months. On multivariate analysis HPV status was a significant predictor of LRR (hazard ratio 0.15; 95% confidence interval 0.05–0.51) and death (hazard ratio 0.29; 95% confidence interval 0.14–0.59) but not distant relapse (hazard ratio 0.53, 95% confidence interval 0.22–1.27). Increasing T-category was associated with a higher risk of LRR (hazard ratio 1.80 for T3/4 versus T1/2; 95% confidence interval 1.08–2.99), death (hazard ratio 1.37, 95% confidence interval 1.06–1.77) and distant relapse (hazard ratio 1.35; 95% confidence interval 1.00–1.83). Increasing GTV-p was associated with increased risk of distant relapse and death. N3 disease and low neck nodes were significant for LRR, distant relapse and death on univariate analysis only.ConclusionTumour HPV status was the strongest predictor of LRR and death. T-category is more predictive of distant relapse and may provide additional prognostic value for LRR and death when accounting for HPV status.     

FDG PET-CT相关参数对鼻咽癌预后影响研究

目的 鼻咽癌是一种具有特殊地域性分布和生物学行为的头颈部肿瘤,研究显示FDG PET-CT相关参数在高发区鼻咽癌预后中具有一定价值。本研究探讨FDG PET-CT相关参数对低发区鼻咽癌的预后价值。方法 回顾分析2003—2013年在Albert Einstein医学院Beth Israel医疗中心诊治的 83例鼻咽癌患者资料,采用梯度法并依据PET-CT图像指导靶区勾画,获取FDG PET-CT参数 SUV_max、MTV、TLG。结果 3年样本数 37例,3年FFS率为74%,3年LRFS率为88%,3年DMFS率为85%。单因素分析结果显示 SUV_max、TLG是 3年LRFS和FFS的影响因素(P=0.004、0.014和 P=0.024、0.033),多因素分析结果显示 SUV_max是 3年FFS的影响因素。结论 治疗前原发肿瘤 SUV_max是影响鼻咽癌患者FFS的因素。     

68例首诊伴单纯骨转移鼻咽癌患者预后分析

目的 探讨首诊伴单纯骨转移鼻咽癌患者的预后影响因素。方法 选取1997—2015年汕头大学医学院附属肿瘤医院收治的68例首诊伴单纯骨转移鼻咽癌患者,49接受放化疗。Kanplan-Meier法计算OS率,Logrank法单因素预后分析,Cox模型多因素预后分析。结果 中位随访时间为95.3个月,1、2、3、5年OS率分别为53%、38%、21%、15%,中位OS期13.4个月。单因素分析结果显示脊柱转移、骨转移数目、疗前LDH水平、原发病灶放疗技术、放疗剂量、原发病灶近期疗效均是影响OS期因素(P=0.02、0.01、0.00、0.02、0.02、0.01),多因素分析显示骨转移数目≤3个、原发病灶放疗剂量>65 Gy、IMRT技术是影响OS期的因素(P=0.03、0.02、0.04)。结论 对于骨转移数目≤3个的首诊伴单纯骨转移鼻咽癌患者,应予以积极治疗,包括采用IMRT技术、原发病灶放疗剂量>65 Gy,以争取原发病灶的近期疗效达到CR,临床意义重大。     

西妥昔单抗联合适形调强放疗和化疗治疗鼻咽癌的临床分析

目的：：分析西妥昔单抗联合适形调强放疗和化疗治疗鼻咽癌的临床疗效,毒性反应和预后因素。方法：纳入2006年3月至2011年3月在我院初治,无远处转移的Ⅱ～Ⅳ期鼻咽癌共72例。西妥昔单抗初始剂量为400 mg／m2,之后为每周250 mg／m2。所有患者接受适形调强放疗,接受诱导和／或同步化疗。结果：中位随访60.5月（5～110月）。全组患者3年、5年无局部区域复发生存率（local regional recurrence-free survival,LRRFS）、无远处转移生存率（distant metastasis free-survival ,DMFS）、无进展生存率（progression-free survival,PFS）;总生存率（overall survival,OS）分别为86.1％,75.4％;79.2％,67.9％;77.8％,66.7％和88.9％,76.7％。Ⅱ～Ⅲ期和Ⅳ期患者的5年 PFS 及 OS 分别为83.3％,97.1％和51.7％,58.3％。4例患者出现局部区域复发,共有17例患者出现远处转移。死亡14例患者中8例死于单纯远处转移。单因素分析显示肿瘤分期为 PFS 和 OS 的预后因素（P ＝0.0146,P＝0.0021）。分别有62.5％和4.2％患者发生3和4级口腔粘膜炎。14例患者出现颞叶损伤。结论：西妥昔单抗联合 IMRT 加化疗治疗鼻咽癌的临床疗效较好,毒性反应可耐受。值得扩大样本量以及开展前瞻性随机对照试验进一步研究。     

A prognostic scoring system for locoregional control in nasopharyngeal carcinoma following conformal radiotherapy

Purpose: This study established a prognostic scoring system for nasopharyngeal carcinoma (NPC), which estimates the probability of locoregional (LR) control following definitive conformal radiotherapy. METHODS AND MATERIALS: Patients with nondisseminated NPC at initial presentation (n = 630) were enrolled in this study. All patients had magnetic resonance imaging of the head and neck and were treated with conformal radiotherapy. Among them, 93% had concurrent chemotherapy, and 76% had postradiation chemotherapy. The extent of the primary tumor, age at diagnosis, primary tumor size, tumor and nodal classification, histology, and serum lactate dehydrogenase (LDH) level before treatment were included in the analysis for building a prognostic scoring system. The end point for this study was LR control. RESULTS: The prognostic score was defined as the number of adverse prognostic factors present at diagnosis. Four factors had similarly independent prognostic effects (hazard ratio, 2.0-2.6): age >40 years, histologic WHO type I-II, serum LDH level > or =410 U/L, and involvement of two or more sites of the following anatomic structures, i.e., sphenoid floor, clivus marrow, clivus cortex, prevertebral muscles, and petrous bone. The score predicted the 5-year probability of LR control as follows: 0 (15% of the patients), 100%; 1 (42% of the patients), 93%; 2 (29% of the patients), 83%; 3 or higher (13% of the patients), 71%. CONCLUSION: This scoring system is useful in the decision-making for individual patients and the design of clinical trials to improve LR control for advanced-stage NPC.     

Preliminary assessment of magnetic resonance spectroscopic imaging in predicting treatment outcome in patients with prostate cancer at high risk for relapse

The purpose of the study was to determine whether 3D proton magnetic resonance spectroscopic imaging (MRSI) can predict treatment outcome in high risk patients with prostate cancer. Endorectal magnetic resonance imaging (MRI) and 1H-MRSI were performed in 16 patients with prostate cancer who were considered high risk because of clinical stage T3-4, Gleason score>/=8, and/or prostate-specific antigen (PSA) level>20 ng/mL. Patients were treated with chemotherapy/hormone therapy, underwent radical prostatectomy (RP) or radiation therapy, and were followed for PSA relapse (follow-up, 19-43 months). The ratio of choline plus creatine to citrate was used to localize peripheral zone cancer. An MRSI risk score on a scale of 0-3 was derived from the volume and degree of metabolic abnormality. Magnetic resonance spectroscopic imaging risk score, MRI tumor/node (TN) stage, clinical stage, Gleason score, and PSA were used as predictors of pathologic stage in patients treated with RP (n=10) and PSA relapse in all patients. Magnetic resonance imaging TN stage (P<0.01) and MRSI risk score (P<0.05) correlated with pathologic stage, but clinical stage did not (P=0.35). Magnetic resonance imaging TN stage was the only significant predictor of PSA relapse in the univariate analysis (P<0.05). Although the MRSI risk score did not reach significance (P=0.13), 6 patients with a score<0.9 were relapse-free, whereas 7 of 10 patients with a score>0.9 relapsed. Magnetic resonance imaging and MRSI risk assessments agreed in 15 of 16 patients. These preliminary results suggest that tumor metabolic assessment may indicate treatment outcome in high-risk patients with prostate cancer. Although MRSI did not provide added prognostic value to MRI in this small number of patients, MRSI might increase the confidence of the clinician in assessing risk on MRI by contributing supporting metabolic data.     

Preliminary results of radiation dose escalation for locally advanced nasopharyngeal carcinoma

PURPOSE: To study the safety and efficacy of dose escalation in tumor for locally advanced nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS: From September 2000 to June 2004, 50 patients with T3-T4 NPC were treated with intensity-modulated radiotherapy (IMRT). Fourteen patients had Stage III and 36 patients had Stage IVA-IVB disease. The prescribed dose was 76 Gy to gross tumor volume (GTV), 70 Gy to planning target volume (PTV), and 72 Gy to enlarged neck nodes (GTVn). All doses were given in 35 fractions over 7 weeks. Thirty-four patients also had concurrent cisplatin and induction or adjuvant PF (cisplatin and 5-fluorouracil). RESULTS: The average mean dose achieved in GTV, GTVn, and PTV were 79.5 Gy, 75.3 Gy, and 74.6 Gy, respectively. The median follow-up was 25 months, with 4 recurrences: 2 locoregional and 2 distant failures. All patients with recurrence had IMRT alone without chemotherapy. The 2-year locoregional control rate, distant metastases-free and disease-free survivals were 95.7%, 94.2%, and 93.1%, respectively. One treatment-related death caused by adjuvant chemotherapy occurred. The 2-year overall survival was 92.1%. CONCLUSIONS: Dose escalation to 76 Gy in tumor is feasible with T3-T4 NPC and can be combined with chemotherapy. Initial results showed good local control and survival.     

527例鼻咽癌患者调强放射治疗后第二原发癌的临床特征分析

目的 分析鼻咽癌患者调强放疗后第二原发癌的临床特征。方法 回顾性分析2007年1月至2011年12月行根治性调强放疗527例鼻咽癌患者的临床和随访资料,分析其调强放疗后第二原发癌的特征。结果 全组患者中位随访时间为45.5个月(4.0~97.0个月),出现第二原发癌12例,发生于照射野内、野外各6例,发生部位肺3例、舌2例、颈部2例、肾2例、脑1例、口腔1例、胃1例。全组患者第二原发癌1年、3年和5年累计发生风险率分别为0.4%、1.4%和3.1%,照射野内1年、3年和5年第二原发癌累计发生风险率分别为0.4%、0.8%和1.5%。不同性别、年龄、临床分期、放疗时间及有无化疗患者调强放疗后第二原发癌的累计发生风险率差异无统计学意义(P>0.05)。结论 上呼吸消化道是鼻咽癌调强放疗后第二原发癌最常见的发生部位,肺癌是最常见的第二原发癌。     

Expressions of Ku70 and DNA-PKcs as prognostic indicators of local control in nasopharyngeal carcinoma

PURPOSE: The objective of this study was to determine whether the expressions of the two components of DNA-dependent protein kinase, Ku70 and DNA-protein kinase catalytic subunit (DNA-PKcs), influence the response to radiotherapy (RT) and outcome of treatment of nondisseminated nasopharyngeal carcinoma (NPC) in patients who received definitive RT. METHODS AND MATERIALS: Sixty-six patients with NPC who were treated with radiotherapy alone or with concurrent chemotherapy between June 1995 and December 2001 were divided into groups based on the levels of immunoreactivity for Ku70 and DNA-PKcs in pretreatment biopsy specimens. The overexpression of Ku70 or DNA-PKcs groups included patients whose biopsy specimens showed at least 50% immunopositive tumor cells; patients in which less than 50% of the tumor cells in the biopsy tissues were immunopositive were placed in the low Ku70 and DNA-PKcs groups. The immunoreactivities for Ku70 and DNA-PKcs were retrospectively compared with the sensitivity of the tumor to radiation and the patterns of therapy failure. Univariate analyses were performed to determine the prognostic factors that influenced locoregional control of NPC. RESULTS: The 5-year locoregional control rate was significantly higher in the low Ku70 group (Ku-) (85%) than in the high Ku70 group (Ku+) (42%) (p = 0.0042). However, there were no differences in the metastases-free survival rates between the 2 groups (Ku70+, 82%; Ku70- 78%; p = 0.8672). Univariate analysis indicated that the overexpression of Ku70 surpassed other well-known predictive clinicopathologic parameters as an independent prognostic factor for locoregional control. Eighteen of 22 patients who had locoregional recurrences of the tumor displayed an overexpression of Ku70. No significant association was found between the level of DNA-PKcs expression and the clinical outcome. CONCLUSIONS: Our data suggest that the level of Ku70 expression can be used as a molecular marker to predict the response to RT and the locoregional control after RT and concurrent chemotherapy in patients with nondisseminated NPC.     

527例鼻咽癌患者调强放射治疗后第二原发癌的临床特征分析

目的 分析鼻咽癌患者调强放疗后第二原发癌的临床特征。方法 回顾性分析2007年1月至2011年12月行根治性调强放疗527例鼻咽癌患者的临床和随访资料,分析其调强放疗后第二原发癌的特征。结果 全组患者中位随访时间为45.5个月(4.0~97.0个月),出现第二原发癌12例,发生于照射野内、野外各6例,发生部位肺3例、舌2例、颈部2例、肾2例、脑1例、口腔1例、胃1例。全组患者第二原发癌1年、3年和5年累计发生风险率分别为0.4%、1.4%和3.1%,照射野内1年、3年和5年第二原发癌累计发生风险率分别为0.4%、0.8%和1.5%。不同性别、年龄、临床分期、放疗时间及有无化疗患者调强放疗后第二原发癌的累计发生风险率差异无统计学意义(P>0.05)。结论 上呼吸消化道是鼻咽癌调强放疗后第二原发癌最常见的发生部位,肺癌是最常见的第二原发癌。     

Locoregional radiotherapy in patients with distant metastases of nasopharyngeal carcinoma at diagnosis

Systemic chemotherapy is the basic palliative treatment for metastatic nasopharyngeal carcinoma （NPC）; however, it is not known whether Iocoregional radiotherapy targeting the primary tumor and regional lymph nodes affects the survival of patients with metastatic NPC. Therefore, we aimed to retrospectively evaluate the benefits of Iocoregional radiotherapy. A total of 408 patients with metastatic NPC were included in this study. The mortality risks of the patients undergoing supportive treatment and those undergoing chemotherapy were compared with that of patients undergoing Iocoregional radiotherapy delivered alone or in combination with chemotherapy. Univariate and multivariate analyses were conducted. The contributions of independent factors were assessed after adjustment for covariates with significant prognostic associations （P 〈 0.05）. Both Iocoregional radiotherapy and systemic chemotherapy were identified as significant independent prognostic factors of overall survival （OS）. The mortality risk was similar in the group undergoing Iocoregional radiotherapy alone and the group undergoing systemic chemotherapy alone [multi-adjusted hazard ratio （HR） = 0.9, P = 0.529]; this risk was 60% lower than that of the group undergoing supportive treatment （HR = 0.4, P = 0.004） and 130% higher than that of the group undergoing both systemic chemotherapy and Iocoregional radiotherapy （HR = 2.3, P 〈 0.001）. In conclusion, Iocoregional radiotherapy, particularly when combined with systemic chemotherapy, is associated with improved survival of patients with metastatic NPC.     

鼻咽癌IMRT同期EGFR单抗和同期化疗与单纯IMRT的回顾对照研究

目的 回顾性对比IMRT同期EGFR单抗、同期化疗和单纯IMRT治疗鼻咽癌的疗效及不良反应。方法 将2008—2012年间收治的68例接受IMRT同期EGFR单抗的Ⅱ—Ⅳ_b期初治鼻咽癌患者纳入BRT组,应用SAS软件进行1∶2配对形成单纯IMRT (IMRT)组136例及同期放化疗(CCRT)组136例,共340例。Kaplan-Meier法计算生存率并Logrank检验,Cox模型分析预后因素。结果 BRT、IMRT、CCRT组3年样本数分别为14、69、47例。全组3年OS、DFS、LRC、DMFS分别为91.2%、80.2%、93.1%、87.2%。BRT、IMRT、CCRT组的3年OS分别为91.9%、 92.1%、89.9%(P=0.379),3年DFS分别为82.1%、77.9%、81.6%(P=0.594),3年LRCR分别为98.2%、90.6%、93.0%(P=0.249),3年DMFS分别为85.2%、85.2%、90.3%(P=0.383)。多因素分析提示T分期及同期EGFR单抗是LRC的影响因素(P=0.034、0.032)。结论 鼻咽癌单纯IMRT即可达较好疗效。三组之间整体疗效相近,但BRT组有提高LRC的趋势。     

治疗前纤维蛋白原联合中性粒细胞淋巴细胞比值对鼻咽癌调强放疗患者预后的预测价值

目的:探讨治疗前纤维蛋白原（Fib）与中性粒细胞淋巴细胞比值（NLR）的联合指标（F-NLR评分）在接受调强放射治疗（IMRT）的鼻咽癌（NPC）患者中的预后价值。方法:回顾性分析我院放疗科2016年1月至2018年12月收治的接受IMRT的NPC患者的临床资料。根据受试者工作特征曲线计算Fib及NLR的最佳截断值,并对患者进行分组。采用χ2检验或Fisher确切概率法比较不同分组间临床特征和近期疗效的差异。运用Cox比例风险模型进行单因素和多因素生存分析,探讨影响预后的风险因素。通过Kaplan-Meier法绘制生存曲线,采用Log-rank法比较各组生存曲线的差异。P＜0.05为差异具有统计学意义。结果:Fib和NLR的最佳截断值分别为3.455 g/L和2.99。不同F-NLR分组的饮酒和T分期存在显著差异。不同Fib、NLR和F-NLR分组的近期疗效存在显著差异。多因素分析显示F-NLR评分、TNM分期和EBV DNA拷贝数是影响NPC患者OS的独立危险因素。不同F-NLR分组的OS和PFS生存曲线两两之间存在显著差异(P＜0.001)。结论:治疗前高F-NLR评分是接受IMRT的NPC患者的独立预后不良因素,联合TNM分期和EBV DNA拷贝数可更加准确预测鼻咽癌患者预后。     

鼻咽癌不同外照射设野放疗后局部区域复发部位的分析

[目的]探讨不同外照射设野放疗后局部区域复发部位的特点,为临床合理设野提供参考。[方法]对2002年1月￣2004年12月131例鼻咽癌复发病人,按传统、常规、三维适形放疗和调强放射治疗三种设野分别统计局部区域复发部位,并进行比较分析。[结果]常规设野在颈动脉鞘复发低于传统设野(32.4%vs.52.5%,P<0.05),而在单纯鼻咽复发、颅底复发、上颈淋巴结复发无明显差异(P>0.05)。三维及调强放疗组8例中6例病人局部复发,3例病人区域淋巴结复发。[结论]鼻咽癌放疗后局部区域复发以颈动脉鞘区、颅底及颈部为主;常规设野符合鼻咽癌的临床行为特性及剂量学原则,与传统设野相比,显示出一定的优势;三维和调强放疗具有潜在的优势,但还需要进一步的病例积累后才能得出结果。