CAJ | 학술논문

目的验证第7版UICC或AJCC鼻咽癌分期系统在以MR为分期手段、IMRT为基础综合治疗策略下的合理性及适用性.方法回顾分析2007-2011年间在本院经MRI分期和IMRT治疗的720例初诊M0期鼻咽癌患者的生存及失败情况,评价T、N分期对预测患者生存及失败的可靠性.Kaplan-Meier计算生存率,Logrank法检验差异,Cox模型多因素预后分析.结果第7版UICC或AJCC鼻咽癌T分期是OS、CSS、DFS和DMFS的影响因素(P=0.013、0.025、0.001、0.002),但T1、T2、T3期间相近(P=0.054 ～0.626).从局部复发和远转风险来看,T3与T2期非常接近(P=0.796).N分期是DFS、DMFS的影响因素(P=0.005,0.000).但N0和N1期间相近(P=0.549、0.707).在N0-N1期中也未发现单纯咽后淋巴结转移对OS、DFS和DMFS有影响(P=0.360、0.083、0.062).结论第7版UICC或AJCC鼻咽癌分期系统对经MRI分期和IMRT的鼻咽癌患者预后仍有较好预测价值,但有进一步优化的空间.
목적 험증제7판UICC혹AJCC비인암분기계통재이MR위분기수단、IMRT위기출종합치료책략하적합이성급괄용성.방법 회고분석2007-2011년간재본원경MRI분기화IMRT치료적720례초진M0기비인암환자적생존급실패정황,평개T、N분기대예측환자생존급실패적가고성.Kaplan-Meier계산생존솔,Logrank법검험차이,Cox모형다인소예후분석.결과 제7판UICC혹AJCC비인암T분기시OS、CSS、DFS화DMFS적영향인소(P=0.013、0.025、0.001、0.002),단T1、T2、T3기간상근(P=0.054 ～0.626).종국부복발화원전풍험래간,T3여T2기비상접근(P=0.796).N분기시DFS、DMFS적영향인소(P=0.005,0.000).단N0화N1기간상근(P=0.549、0.707).재N0-N1기중야미발현단순인후림파결전이대OS、DFS화DMFS유영향(P=0.360、0.083、0.062).결론 제7판UICC혹AJCC비인암분기계통대경MRI분기화IMRT적비인암환자예후잉유교호예측개치,단유진일보우화적공간.
Objective To evaluate the rationality and applicability of the 7th edition of the International Union against Cancer/American Joint Committee on Cancer (UICC/AJCC) staging system for nasopharyngeal carcinoma (NPC) in patients staged by magnetic resonance imaging (MRI) and treated with intensity-modulated radiotherapy (IMRT).Methods The clinical outcomes of 720 patients diagnosed with stage M0 NPC who were staged by MRI and treated with IMRT in our hospital from 2007 to 2011 were retrospectively analyzed,and the reliability of T and N staging in prediction of clinical outcomes in patients was evaluated.The survival rates were calculated using the Kaplan-Meier method,and pairwise comparisons were made using the log-rank test.Multivariate prognostic analyses were performed using the Cox regression model.Results The 7th edition of UICC/AJCC T stag was an independent prognostic factor for overall survival (OS),cancer-specific survival (CSS),disease-free survival (DFS),and distant metastasis-free survival (DMFS) rates (P =0.013,0.025,0.001,and 0.002).However,differences between stages T1,T2,and T3 were not significant (P =0.054-0.626).Patients with stage T3 NPC had a similar level of risk for local recurrence and distant metastasis compared with patients with stage T2 NPC (P =0.796).The N stage was an independent prognostic factor for DFS and DMFS rates (P =0.005 and 0.000).There were no significant differences in DFS and DMFS rates between stages N0 and N1 (P =0.549 and 0.707).In stages N0-N1,retropharyngeal lymph node metastasis only was not an independent prognostic factor for OS,DFS,and DMFS (P =0.360,0.083,and 0.062).Conclusions The 7th edition of UICC/AJCC staging system for NPC is still valuable for prediction of the prognosis of patients staged by MRI and treated by IMRT.Optimization of the staging system can improve the prognostic accuracy.