CAJ | 학술논문

目的探讨转移性鼻咽癌的最佳治疗方法.方法回顾性分析171例资料完整、病理确诊的转移性鼻咽癌患者的临床资料.171例患者分别接受最佳支持治疗(26例)、双药联合化疗(92例)和三药联合化疗(53例).最佳支持治疗是指患者未接受化疗,只接受支持治疗或骨转移疼痛处的姑息性放疗;双药联合化疗是指化疗方案以顺铂(DDP)为基础,联合5-氟尿嘧啶[(5-Fu),FP方案]或紫杉醇[(FIX),TP方案]或多西紫杉醇[(DOC),DP方案];三药联合化疗是指在FP方案的基础卜加用FIX(TFP方案)或DOC(DFP方案).比较3种治疗方法的疗效、生存时间、毒副作用和预后影响因素.结果三药联合化疗组的有效率(RR)为84.9%,显著高于双药组(52.2%,P=0.000).三药联合化疗组Ⅲ～Ⅳ度骨髓抑制和消化道毒副反应的发生率分别为58.5%和64.2%,显著高于双药组(P=0.000和P=O.017).最佳支持治疗组、双药联合化疗组和三药联合化疗组的中位生存期(MST)分别为4.0、13.2和15.0个月,1年生存率分别为24.0%、64.1%和70.3%.两个化疗组患者的MST较最佳支持治疗组显著延长(P=0.000),但双药联合化疗组的MST和1年生存率,与三药联合化疗组相比,差异无统计学意义(P＞0.05).三药联合化疗组中,采用TFP和DFP方案者的RR和MST的差异均无统计学意义(均P＞0.05).双药联合化疗组中,采用FP、TP和DP方案者的RR和MST差异均无统计学意义(均P＞0.05).KPS评分、疾病进展时间(TTP)和化疗周期数是影响转移性鼻咽癌患者生存的独立预后因素(均P＜0.05).结论化疗可以延长转移性鼻咽癌患者的生存期.含铂三药联合方案的RR高,但毒性大.FP方案或第三代化疗药物加铂类的双药联合方案仍是转移性鼻咽癌的标准治疗方案.
목적 탐토전이성비인암적최가치료방법.방법 회고성분석171례자료완정、병리학진적전이성비인암환자적림상자료.171례환자분별접수최가지지치료(26례)、쌍약연합화료(92례)화삼약연합화료(53례).최가지지치료시지환자미접수화료,지접수지지치료혹골전이동통처적고식성방료;쌍약연합화료시지화료방안이순박(DDP)위기출,연합5-불뇨밀정[(5-Fu),FP방안]혹자삼순[(FIX),TP방안]혹다서자삼순[(DOC),DP방안];삼약연합화료시지재FP방안적기출복가용FIX(TFP방안)혹DOC(DFP방안).비교3충치료방법적료효、생존시간、독부작용화예후영향인소.결과 삼약연합화료조적유효솔(RR)위84.9%,현저고우쌍약조(52.2%,P=0.000).삼약연합화료조Ⅲ～Ⅳ도골수억제화소화도독부반응적발생솔분별위58.5%화64.2%,현저고우쌍약조(P=0.000화P=O.017).최가지지치료조、쌍약연합화료조화삼약연합화료조적중위생존기(MST)분별위4.0、13.2화15.0개월,1년생존솔분별위24.0%、64.1%화70.3%.량개화료조환자적MST교최가지지치료조현저연장(P=0.000),단쌍약연합화료조적MST화1년생존솔,여삼약연합화료조상비,차이무통계학의의(P＞0.05).삼약연합화료조중,채용TFP화DFP방안자적RR화MST적차이균무통계학의의(균P＞0.05).쌍약연합화료조중,채용FP、TP화DP방안자적RR화MST차이균무통계학의의(균P＞0.05).KPS평분、질병진전시간(TTP)화화료주기수시영향전이성비인암환자생존적독립예후인소(균P＜0.05).결론 화료가이연장전이성비인암환자적생존기.함박삼약연합방안적RR고,단독성대.FP방안혹제삼대화료약물가박류적쌍약연합방안잉시전이성비인암적표준치료방안.
Objective The aim of this study was to compare the results of different combined chemotherapy regimens and to find the best regimen for metastatic nasopharyngeal carcinoma(NPC),and determine its prognostic hetom.Methotis The clinical data of 171 patients with pathologically proven metastatic NPC were retrospectively analyzed.Of them.26 were treated with best support care(BSCgroup),92 with platinum-based reginlell of two drugs(FP group:5-Fu and cisplatin;TP group:paclitaxel and cisplatin:DP group:docetaxel and cisplatin),and 53 with platinum-based regimen of three-drugs(TFP group:FP plus paclitaxel,DFP group:FP plus doxtale).Results The response rate(RR)in the threedrug regimens was significantly higher than that in the two-drug regimen(84.9%vs.52.2%,P=0.000),however,grade Ⅲ～Ⅳ myelosuppression in the three-drug regimen group was also significantly higher than that in the two-drug regimen(58.5%vs.27.2%,P=0.000).Among the groups treated with platinumbased combination regimens of either two drugs or three drugs,no significant differences were observed in RR(P=0.967,P=0.400)or median survival time(MST)(P=0.278,P=0.413).The MST and oneyear survival rate were 4.0 months,13.2 months and 15.0 monks,24.0%,64.1%and 70.3%in the BSC group,two-drug group and three-drag group,respectively.The MST in the chemotherapy group was significantly longer than that in BSC group(P=0.000).Cox multivariate regression analysis showed that Kamovsky performance scores,time to progression or chemotherapy eyeles were independent prognostic factors(P＜0.05).Conclusion Chemotherapy can improve the survival of metastatic NPC.Platinumbased combination regimen with two drugs is still the standard treatment.The combination regimens with three drugs can increase the RR,but no survival benefit can be achieved for its high toxicity.