治疗前血浆EB病毒DNA载量和不同治疗方式对Ⅲ期鼻咽癌疗效及预后的影响

doi:10.3760/cma.j.cn371439-20200615-00014

摘要/Abstract

摘要：

目的探讨治疗前血浆不同EB病毒(EBV)DNA载量和诱导化疗+放疗、同步放化疗两种治疗方式对Ⅲ期鼻咽癌患者疗效及预后的影响。方法选择2012年1月至2019年3月湖北省咸宁市第一人民医院耳鼻喉科收治的178例Ⅲ期鼻咽癌患者为研究对象,其中44例患者接受了辅助化疗。以治疗前EBV DNA载量1 000拷贝/ml为界,将患者分为高病毒载量组(EBV DNA≥1 000拷贝/ml,n=53)和低病毒载量组(EBV DNA<1 000拷贝/ml,n=125),其中高病毒载量组14例患者接受了辅助化疗,低病毒载量组30例患者接受了辅助化疗;根据治疗方式将患者分为诱导化疗+放疗组(n=105)和同步放化疗组(n=73)。比较各组患者的一般临床资料、复发率、5年总生存(OS)率、无瘤生存(DFS)率、局部无复发生存(LRFS)率和无远处转移生存(DMFS)率。结果 178例Ⅲ期鼻咽癌患者复发34例,占19.10%;死亡29例,占16.29%。诱导化疗+放疗组与同步放化疗组N分期比较,差异有统计学意义(χ²=6.40,P=0.01)。高病毒载量组患者肿瘤复发率为33.96%(18/53),低病毒载量组为12.80%(16/125),差异有统计学意义(χ²=10.79,P<0.01)。高病毒载量组患者淋巴结转移复发率[(9.43%(5/53) vs. 1.60%(2/125),χ²=4.15,P=0.04]、远处转移率[18.87%(10/53) vs. 5.60%(7/125),χ²=7.59,P=0.01]明显高于低病毒载量组,差异均具有统计学意义。诱导化疗+放疗组患者肿瘤复发率为17.14%(18/105),同步放化疗组为21.91%(16/73),差异无统计学意义(χ²=0.63,P=0.43)。178例Ⅲ期鼻咽癌患者5年OS率、DFS率、LRFS率和DMFS率分别为84.68%、72.80%、79.68%和79.54%。高病毒载量组患者5年OS率(79.25% vs. 92.80%,χ²=6.86,P<0.01)、DFS率(73.58% vs. 88.00%,χ²=5.67,P=0.01)、LRFS率(73.21% vs. 89.24%,χ²=8.32,P<0.01)、DMFS率(65.24% vs. 78.00%,χ²=4.15,P=0.02)均明显低于低病毒载量组患者,差异均具有统计学意义。诱导化疗+放疗组患者5年OS率(89.52% vs. 87.67%,χ²=0.15,P=0.70)、DFS率(84.76% vs. 82.19%,χ²=0.21,P=0.65)、LRFS率(80.38% vs. 79.84%,χ²=0.00,P=1.00)和DMFS率(79.52% vs. 81.78%,χ²=0.05,P=0.83)与同步放化疗组相比,差异均无统计学意义。44例接受辅助化疗患者的5年OS率(93.77% vs. 87.49%)显著高于未接受辅助化疗患者,差异有统计学意义(χ²=5.21,P=0.02)。高病毒载量组中,接受辅助化疗患者的5年OS率(93.77% vs. 84.13%)显著高于未接受辅助化疗患者,差异具有统计学意义(χ²=5.11,P=0.03)。结论诱导化疗+放疗能达到与同步放化疗相同的疗效。高病毒载量与较高的复发率和较差的生存率相关,对于这些高病毒载量患者需要加强治疗强度。

关键词: 鼻咽肿瘤, 疱疹病毒4型,人, 化放疗

Abstract:

Objective To study the effects of different Epstein-Barr virus (EBV) DNA load, induction chemotherapy+radiotherapy and concurrent radiochemotherapy on patients with stage Ⅲ nasopharyngeal carcinoma (NPC). Methods A total of 178 patients with stage Ⅲ NPC were selected as the study subjects in the Department of Otorhinolaryngology of the First People's Hospital of Xianning of Hubei Province from January 2012 to March 2019, including 44 patients received adjuvant chemotherapy. According to the pre-treatment EBV DNA load of 1 000 copies/ml, the patients were divided into high viral load group (EBV DNA≥1 000 copies/ml, n=53) and low viral load group (EBV DNA<1 000 copies/ml, n=125), and 14 patients in the high viral load group and 30 patients in the low viral load group received adjuvant chemotherapy. According to treatment method, the patients were divided into induction chemotherapy+radiotherapy group (n=105) and concurrent radiochemotherapy group (n=73). The general clinical data, recurrence rate, 5-year overall survival (OS) rate, disease free survival (DFS) rate, local recurrence free survival (LRFS) rate and disease metastasis-free survival (DMFS) rate of each group were compared. Results Among 178 patients with stage Ⅲ NPC, 34 cases recurred, accounting for 19.10%, and 29 cases died, accounting for 16.29%. There was a statistically significant difference in N staging between the induction chemotherapy+radiotherapy group and the concurrent radiochemotherapy group (χ²=6.40, P=0.01). The tumor recurrence rate in the high viral load group was 33.96% (18/53), and that in the low viral load group was 12.80% (16/125), and there was a statistically significant difference (χ²=10.79, P<0.01). The recurrence rate of lymph nodes [(9.43% (5/53) vs. 1.60% (2/125), χ²=4.15, P=0.04], the distant metastasis rate [18.87% (10/53) vs. 5.60% (7/125), χ²=7.59, P=0.01] were significantly higher than those in the low viral load group, and there were statistically significant differences. The tumor recurrence rate of patients in the induction chemotherapy+radiotherapy group was 17.14% (18/105), and that in the concurrent radiochemotherapy group was 21.91% (16/73), and there was no statistically significant difference (χ²=0.63, P=0.43). The 5-year OS rate, DFS rate, LRFS rate and DMFS rate of 178 patients with stage Ⅲ NPC were 84.68%, 72.80%, 79.68% and 79.54%, respectively. The 5-year OS rate (79.25% vs. 92.80%, χ²=6.86, P<0.01), DFS rate (73.58% vs. 88.00%, χ²=5.67, P=0.01), LRFS rate (73.21% vs. 89.24%, χ²=8.32, P<0.01) and DMFS rate (65.24% vs. 78.00%, χ²=4.15, P=0.02) in the high viral load group were significantly lower than those in the low viral load group, and there were statistically significant differences. The 5-year OS rate (89.52% vs. 87.67%, χ²=0.15, P=0.70), DFS rate (84.76% vs. 82.19%, χ²=0.21, P=0.65), LRFS rate (80.38% vs. 79.84%, χ²=0.00, P=1.00) and DMFS rate (79.52% vs. 81.78%, χ²=0.05, P=0.83) in the induction chemotherapy+radiotherapy group were not statistically significant compared with those in the concurrent radiochemotherapy group, and there were no statistically significant differences. The 5-year OS rate of 44 patients receiving adjuvant chemotherapy was significantly higher than that of patients who did not receive adjuvant chemotherapy (93.77% vs. 87.49%), and there was a statistically significant difference (χ²=5.21, P=0.02). In the high viral load group, the 5-year OS rate of patients receiving adjuvant chemotherapy was significantly higher than that of patients who did not receive adjuvant chemotherapy (93.77% vs. 84.13%), and there was a statistically significant difference (χ²=5.11, P=0.03). Conclusion Induction chemotherapy+radiotherapy can achieve the same therapeutic effect as concurrent radiochemotherapy. High viral load is associated with high recurrence rate and poor survival rate. For these patients with high viral load, treatment intensity needs to be strengthened.

Key words: Nasopharyngeal neoplasms, Herpesvirus 4, human, Chemoradiotherapy

朱雷, 黄剑波. 治疗前血浆EB病毒DNA载量和不同治疗方式对Ⅲ期鼻咽癌疗效及预后的影响[J]. 国际肿瘤学杂志, 2021, 48(2): 74-79.

Zhu Lei, Huang Jianbo. Effects of Epstein-Barr virus DNA load and different treatment methods on the therapeutic effect and prognosis of stage Ⅲ nasopharyngeal carcinoma[J]. Journal of International Oncology, 2021, 48(2): 74-79.

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