肿瘤体积在鼻咽癌不同分期系统中的意义比较

目的根据鼻咽癌（nasopharyngeal carcinoma,NPC）原发灶肿瘤、颈部转移淋巴结体积大小分别在鼻咽癌中国2008分期与美国癌症研究联合会（American Joint Committee on Cancer,AJCC）分期中的关系进行比较,验证两种分期系统中T分期、N分期的合理性。方法将100例鼻咽癌患者治疗前行磁共振增强扫描后,应用美国CMS适形调强4.0治疗计划系统进行NPC原发肿瘤靶区鼻咽部大体肿瘤体积（nasopharynx gross tumor volume,GTVnx）及颈部阳性淋巴结大体肿瘤体积（lymph node gross tumor volume,GTVnd）勾画和体积计算。结果在鼻咽癌T分期中,中国2008分期原发病灶肿瘤体积大小在不同T分期之间差异具有统计学意义（P=0.000）,两两比较中T2、T3分期差别不大,差异无统计学意义（P=0.225）;第7版AJCC分期中,原发病灶肿瘤体积大小在不同T分期之间差异具有统计学意义（P=0.000）,且两两比较,各组之间差异均有统计学意义（均P〈0.05）。在鼻咽癌N分期中,两种分期系统颈部转移淋巴结体积大小在不同N分期之间差异具有统计学意义（P=0.0008）,两两比较相邻N分期之间差异无统计学意义（均P〉0.05）。结论鼻咽癌原发灶肿瘤、颈部转移淋巴结体积与两种分期均具有相关性,建议将体积因素作为预后判断指标,鼻咽癌第7版AJCC系统在T2、T3分期较中国2008分期合理,建议中国2008分期进一步细化。

Comparison of tumor volume between different nasopharyngeal carcinoma staging systems

Objective To compare the Chinese 2008 staging system and American Joint Committee on Cancer（AJCC） staging system regarding primary nasopharynx gross tumor volume（GTVnx） and metastatic neck lymph node gross tumor volume（GTVnd） in nasopharyngeal carcinoma（NPC）,and to evaluate the rationality of T and N categories in the two staging systems.Methods After 100 patients with NPC were examined with enhanced MRI before treatment,the CMS Xi O Comprehensive Radiotherapy Treatment Planning System（CMS 4.0） was used to outline and calculate the primary GTVnx and positive GTVnd.Results For the Chinese 2008 staging system,the primary gross tumor volume（GTV） in different T subcategories varied with statistical significance（P = 0.000）;however,a pairwise comparison of GTV in T2 and T3showed no significant difference（P = 0.225）.As for the 7th edition of the AJCC staging system,the primary GTV in different T subcategories varied with significant difference（P = 0.000）;in pairwise comparison among all groups,the differences were statistically significant（all P 〈 0.05）.For N subcategories of NPC,metastatic GTVnd of different N subcategories of the two staging systems varied with significant difference（P = 0.0008）;however,in pairwise comparison between neighboring N subcategories,no statistically significant difference was observed（all P 〉 0.05）.Conclusion Primary GTVnx and metastatic GTVnd are related to the categories in the two staging systems.GTV may be used as a prognostic indicator.For NPC,T2 and T3subcategories in the 7th edition of AJCC staging system are more rational than those in the Chinese 2008 staging system.The Chinese 2008 staging system should be further refined.