国际肿瘤学杂志

国际肿瘤学杂志 ›› 2021, Vol. 48 ›› Issue (9): 515-522.doi: 10.3760/cma.j.cn371439-20201214-00100

• 论著 • 上一篇    下一篇

调强放疗鼻咽癌患者UICC第7版与第8版T分期预后差异

陈方明1, 蔡园园2, 李晗3, 王晓丽2, 阚红星4, 李洋2, 郝福荣2(), 王明臣2()   

  1. 1山东省威海市荣成市人民医院放疗科 264300
    2山东省潍坊市人民医院放疗科 潍坊市放射物理与肿瘤放射生物学重点实验室 261041
    3山东省淄博市第四人民医院肿瘤科255022
    4山东省烟台毓璜顶医院放疗科 264001
  • 收稿日期:2020-12-14 修回日期:2021-01-09 出版日期:2021-09-08 发布日期:2021-09-22
  • 通讯作者: 郝福荣,王明臣 E-mail:hkc515@163.com;flk2291@163.com
  • 基金资助:
    潍坊市科技发展计划(2019YX003)

Prognostic differences of nasopharyngeal carcinoma patients treated with intensity-modulated radiothe-rapy with different T staging of the seventh and eighth edition of the UICC staging system

Chen Fangming1, Cai Yuanyuan2, Li Han3, Wang Xiaoli2, Kan Hongxing4, Li Yang2, Hao Furong2(), Wang Mingchen2()   

  1. 1Department of Radiation Oncology, Rongcheng People's Hospital of Weihai City of Shandong Province, Weihai 264300, China
    2Department of Radiation Oncology, Weifang People's Hospital of Shandong Province, Weifang Key Laboratory of Radiophysics and Oncological Radiobiology, Weifang 261041, China
    3Department of Oncology, Fourth People's Hospital of Zibo City of Shandong Province, Zibo 255022, China
    4Department of Radiation Oncology, Yantai Yuhuangding Hospital of Shandong Province, Yantai 264001, China
  • Received:2020-12-14 Revised:2021-01-09 Online:2021-09-08 Published:2021-09-22
  • Contact: Hao Furong,Wang Mingchen E-mail:hkc515@163.com;flk2291@163.com
  • Supported by:
    Science and Technology Development Project of Weifang City of Shandong Province of China(2019YX003)

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摘要：

目的 比较调强放疗鼻咽癌在国际抗癌联盟(UICC)鼻咽癌第7版(简称UICC 7版)与第8版(简称UICC 8版)T分期的人群分布和预后差异,并分析鼻咽癌患者的预后影响因素。方法 回顾性分析2005年6月1日至2017年12月31日山东省潍坊市人民医院放疗科收治的184例初治调强放疗鼻咽癌患者的临床病理资料,按UICC 7版、UICC 8版对入组病例进行重新分期,分析两版分期系统患者T分期的分布,采用Kappa一致性检验比较两种分期的一致性。采用Kaplan-Meier法进行生存分析,log-rank检验比较各T分期之间的预后差异。采用Cox回归模型分析鼻咽癌患者的预后影响因素。结果 184例调强放疗鼻咽癌患者按UICC 7版T分期,T1、T2、T3和T4期分别占18.5%(34/184)、16.8%(31/184)、15.2%(28/184)、49.5%(91/184),而按UICC 8版T分期,分别占18.5%(34/184)、34.2%(63/184)、30.4%(56/184)和16.8%(31/184),两版分期系统的T分期人群分布具有中度一致性(Kappa=0.58)。UICC 7版分期中,T1、T2、T3、T4期患者的总生存期(OS)差异有统计学意义(χ2=10.606,P=0.014),T1与T2、T3、T4期患者的OS差异均有统计学意义(χ2=4.866,P=0.027;χ2=11.965,P=0.001;χ2=4.351,P=0.037),T2、T4期OS曲线不能分离,T3、T4期OS曲线倒序分布;UICC 8版分期中,4期患者的OS差异有统计学意义(χ2=8.663,P=0.034),T1与T3、T4期患者的OS差异均有统计学意义(χ2=8.746,P=0.003;χ2=7.580,P=0.006),T1~T4期的OS曲线顺序分布,T3与T4期OS曲线仍未能分离。UICC 7版分期中,T1、T2、T3、T4期患者的无进展生存期(PFS)差异有统计学意义(χ2=11.289,P=0.010),T1与T2、T3、T4期患者的PFS差异均有统计学意义(χ2=8.209,P=0.004;χ2=13.302,P<0.001;χ2=6.550,P=0.010),T2、T4期PFS曲线不能分离,T3、T4期PFS曲线倒序分布;UICC 8版分期中,4期患者的PFS差异有统计学意义(χ2=12.074,P=0.007),T1与T2、T3、T4期患者的PFS差异均有统计学意义(χ2=5.182,P=0.023;χ2=11.217,P=0.001;χ2=10.174,P=0.001),T1~T4期的PFS曲线顺序分布,但T3与T4期PFS曲线未能分离。分别按UICC 7版和8版分期行Cox多因素分析,结果显示两版分期中T分期均是患者OS(P=0.013;P=0.026)、PFS(P=0.031;P=0.012)的独立预后因素,但两版分期中T分期均不是患者无局部复发生存期(LRFS)(P=0.351;P=0.167)、无远处转移生存期(DMFS)(P=0.059;P=0.052)的独立预后因素;两版分期中年龄均是影响OS(HR=2.70,95%CI为1.53~4.76,P=0.001;HR=2.74,95%CI为1.55~4.84,P=0.001)、PFS(HR=2.72,95%CI为1.46~5.08,P=0.002;HR=2.94,95%CI为1.57~5.52,P=0.001)、LRFS(HR=5.87,95%CI为1.62~21.27,P=0.007;HR=6.02,95%CI为1.61~22.49,P=0.008)及DMFS(HR=2.40,95%CI为1.22~4.72,P=0.011;HR=2.63,95%CI为1.34~5.18,P=0.005)的独立预后因素,N分期是影响OS(P=0.031;P=0.028)的独立预后因素。结论 UICC 7版与8版分期系统的T分期人群分布具有中等一致性,UICC 8版T分期对OS及PFS的预后判断更有优势,两版分期中T分期均是患者OS、PFS的独立预后因素。

关键词: 鼻咽肿瘤, 放射疗法, 肿瘤分期, 预后

Abstract:

Objective To compare the differences in population distribution and prognosis of patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT) in T staging of the Union for International Cancer Control (UICC) 7th edition and UICC 8th edition, and to analyze the prognostic factors in patients with NPC. Methods The clinicopathologic date of 184 patients with newly diagnosed NPC treated with IMRT at the Department of Radiation Oncology of Weifang People's Hospital of Shandong Province from June 1, 2005 to December 31, 2017 were retrospectively analyzed. All patients were restaged according to the 7th and 8th edition of the UICC staging system. The distribution of T staging of patients in the two staging systems was analyzed, and the consistency of the two staging systems was compared using the Kappa consistency test. Kaplan-Meier method was used for survival analysis, and log-rank test was used to compare the prognostic differences among T stages. Cox regression model was used to analyze the prognostic factors of patients with NPC. Results Of all 184 patients with NPC, stage T1, T2, T3 and T4 respectively accounted for 18.5% (34/184), 16.8% (31/184), 15.2% (28/184) and 49.5% (91/184) according to the 7th edition UICC staging system. However, stage T1, T2, T3 and T4 respectively accounted for 18.5% (34/184), 34.2% (63/184), 30.4% (56/184) and 16.8% (31/184) according to the 8th edition UICC staging system. The T staging population distribution of the two staging systems showed moderate consistency (Kappa=0.58). There was a statistically significant difference in overall survival (OS) among patients with stage T1, T2, T3, T4 according to the 7th edition UICC staging system (χ2=10.606, P=0.014). There were statistically significant differences in OS between stage T1 and stage T2, T3, T4 (χ 2=4.866, P=0.027; χ 2=11.965, P=0.001; χ 2=4.351, P=0.037). The OS curves of stage T2 and T4 could not be separated. Moreover, the OS curves of stage T3 and T4 were distributed in reverse order. There was a statistically significant difference in OS among patients with stage T1, T2, T3, T4 according to the 8th edition staging system (χ 2=8.663, P=0.034). There were statistically significant differences in OS between stage T1 and stage T3, T4(χ 2=8.746, P=0.003; χ 2=7.580, P=0.006). The OS curves of stage T1 to T4 were distributed in order, but the curves of stage T3 and T4 could not be separated. There was a statistically significant difference in progression-free survival (PFS) among patients with stage T1, T2, T3, T4 according to the 7th edition UICC staging system (χ 2=11.289, P=0.010). There were statistically significant differences in PFS between stage T1 and stage T2, T3, T4 (χ 2=8.209, P=0.004; χ 2=13.302, P<0.001; χ 2=6.550, P=0.010). The PFS curves of stage T2 and T4 could not be separated. Moreover, the PFS curves of stage T3 and T4 were distributed in reverse order. There was a statistically significant difference in PFS among patients with stage T1, T2, T3, T4 according to the 8th edition staging system (χ 2=12.074, P=0.007). There were statistically significant differences in PFS between stage T1 and stage T2, T3, T4(χ 2=5.182, P=0.023; χ 2=11.217, P=0.001; χ 2=10.174, P=0.001). The PFS curves of stage T1 to T4 were distributed in order, but the curves of stage T3 and T4 could not be separated. The results of Cox multivariate analysis showed that T staging of both staging systems were the independent prognostic factors of the OS (P=0.013; P=0.026) and PFS (P=0.031; P=0.012). However, T staging of the two editions were not the independent prognostic factors of the local recurrence-free survival (LRFS) (P=0.351; P=0.167) and distant metastasis-free survival (DMFS) (P=0.059; P=0.052). The age was the independent prognostic factor of the OS (HR=2.70, 95%CI: 1.53-4.76, P=0.001; HR=2.74, 95%CI: 1.55-4.84, P=0.001), PFS (HR=2.72, 95%CI: 1.46-5.08, P=0.002; HR=2.94, 95%CI: 1.57-5.52, P=0.001), LRFS (HR=5.87, 95%CI: 1.62-21.27, P=0.007; HR=6.02, 95%CI: 1.61-22.49, P=0.008) and DMFS (HR=2.40, 95%CI: 1.22-4.72, P=0.011; HR=2.63, 95%CI: 1.34-5.18, P=0.005). N staging was the independent prognostic factor of the OS (P=0.031; P=0.028). Conclusion The T staging population distribution of the 7th and 8th edition UICC staging system had moderate consistency, and the T staging of the 8th edition is more advantageous in predicting the prognosis of OS and PFS. In both editions, T staging is an independent prognostic factor for OS and PFS.

Key words: Nasopharyngeal neoplasms, Radiotherapy, Neoplasm staging, Prognosis