基于调强放射治疗的鼻咽癌UICC第7版T分期验证及简化推荐

doi:10.19401/j.cnki.1007-3639.2016.12.008

中国癌症杂志 ›› 2016, Vol. 26 ›› Issue (12): 1012-1017.doi: 10.19401/j.cnki.1007-3639.2016.12.008

基于调强放射治疗的鼻咽癌UICC第7版T分期验证及简化推荐

黄　爽，姜　锋，陈媛媛，胡巧英，花永虹，冯星来，金祁峰，金　厅，曹才能，陈晓钟

浙江省肿瘤医院放疗科，浙江杭州 310022

出版日期:2016-12-30 发布日期:2017-01-23
通信作者: 陈晓钟　E-mail: cxzfyun@sina.com

Validation of T classifications in the 7th edition UICC staging system and recommendation of a simplified T classifications based on intensity-modulated radiotherapy

HUANG Shuang, JIANG Feng, CHEN Yuanyuan, HU Qiaoying, HUA Yonghong, FENG Xinglai, JIN Qifeng, JIN Ting, CAO Caineng, CHEN Xiaozhong

Department of Radiotherapy, Zhejiang cancer Hospital, Hangzhou 310022, Zhejiang Province, China

Published:2016-12-30 Online:2017-01-23
Contact: CHEN Xiaozhong E-mail: cxzfyun@sina.com

摘要/Abstract

摘要： 背景与目的：调强放射治疗可以明显提高鼻咽癌的局部控制率，使T分期的预后价值发生改变。本文拟评价接受调强放射治疗的鼻咽癌患者国际抗癌联盟(Union for International Cancer Control，UICC)第7版分期中T分期的预后价值，并对其简化方式进行探讨。方法：回顾浙江省肿瘤医院放疗科2007年1月—2011年6月收治的641例初治鼻咽癌患者的基本资料，采用Kaplan-Meier法及COX回归评价UICC第7版分期中T分期的预后价值。结果：641例患者的5年总生存率(overall survival，OS)、无局部复发生存率(loco-relapse free survival，LRFS)、无进展生存率(progression-free survival，PFS)和无远处转移生存率(distant metastasis free survival，DMFS)分别为85.4%、88.5%、78%和87.1%，其中T₁、T₂、T₃和T₄分期患者的5年OS分别为91.6%、85.3%、90.1%和76.5%，LRFS为93%、85.3%、91.5%和84.4%，PFS为88.2%、77.3%、80.8%和70.9%，DMFS为95.1%、88.9%、88.2%和81.3%。其中T₁、T₂和T₃期的各指标间差异无统计学意义，而T₄期与T₁、T₂和T₃期之间多个预后指标差异均有统计学意义(P<0.05)。将T₁、T₂和T₃期合并为新T₁期，T₄期为新T₂期。新T₁和T₂期的5年OS为89.1%和76.5%(P=0.001)；LRFS为90.1%和84.4%(P=0.028)；PFS为81%和70.9%(P=0.001)；DMFS为90.8%和81.2%(P=0.002)，差异均有统计学意义。在不同的N分期中分别分析，简化的T分期仍有明显的预后预测优势。结论：在调强放射治疗时代，UICC第7版分期中的T分期之间的预后差异不明显，简化T分期能更好地
适应治疗方法的改革和预测预后。

关键词: 鼻咽癌, 调强放射治疗, T分期

Abstract: Background and purpose: The application of intensity-modulated radiotherapy (IMRT) has improved the local control rate of nasopharyngeal carcinoma greatly, which changed the predictive value of T classifications of TNM staging system. This study aimed to validate the predictive effect of T classifications in the 7th Union for International Cancer Control (UICC) staging system and discuss the simplification of T classifications. Methods: We retrospectively reviewed the clinical data of 641 primary nasopharyngeal carcinoma patients at our center from January 2007 to June 2011. We evaluated the predictive effect of T classifications by Kaplan-Meier method and Cox regression model. Results: The 5-year overall survival (OS), local relapse-free survival (LRFS), progression-free survival (PFS) and distant metastasis free survival (DMFS) were 85.4%, 88.5%, 78% and 87.1%, respectively. The 5-year OS of T₁, T₂, T₃ and T₄ categories were 91.6%, 85.3%, 90.1% and 76.5%, respectively; LRFS were 93%, 85.3%, 91.5% and 84.4%; PFS were 88.2%, 77.3%, 80.8% and 70.9%; DMFS were 95.1%, 88.9%, 88.2% and 81.3%, respectively. The difference in survival curves between T₁, T₂ and T₃ were not significant (P>0.05). However, several prognostic indexes were significantly different between T₄ and T₁, T₂, T₃. We merged the T₁, T₂and T₃classifications as new T₁, and the T₄ classification as new T₂. The 5-year OS of new T₁ and T₂ were 89.1% and 76.5% (P=0.001); LRFS were 90.1% and 84.4% (P=0.028); PFS were 81% and 70.9% (P=0.001); DMFS were 90.8% and 81.2% (P=0.002). The survival curves were substantially separated. The simplified T classifications had obvious advantages when separately analyzed in different N stages. Conclusion: In the era of IMRT, the predictive effect of T classifications of the 7th UICC staging system has diminished. The simplification of T classifications can fit with the new treatment and provide a better survival prediction.

Key words: Nasopharyngeal carcinoma, Intensity modulated radiotherapy, T classifications

黄　爽,姜　锋,陈媛媛,等. 基于调强放射治疗的鼻咽癌UICC第7版T分期验证及简化推荐[J]. 中国癌症杂志, 2016, 26(12): 1012-1017.

HUANG Shuang, JIANG Feng, CHEN Yuanyuan, et al. Validation of T classifications in the 7th edition UICC staging system and recommendation of a simplified T classifications based on intensity-modulated radiotherapy[J]. China Oncology, 2016, 26(12): 1012-1017.

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基于调强放射治疗的鼻咽癌UICC第7版T分期验证及简化推荐

Validation of T classifications in the 7th edition UICC staging system and recommendation of a simplified T classifications based on intensity-modulated radiotherapy

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