COMPARISON OF TREATMENT RESULTS BETWEEN ADULT AND JUVENILE NASOPHARYNGEAL CARCINOMA
COMPARISON OF TREATMENT RESULTS BETWEEN ADULT AND JUVENILE NASOPHARYNGEAL CARCINOMA
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DOI：
10.1016/j.ijrobp.2008.12.030
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发表时间：
2009-11-15
影响因子：
7
通讯作者：
Le, Quynh-Thu
中科院分区：
文献类型：
--
作者：
Downing, N. Lance;Wolden, Suzanne;Le, Quynh-Thu
目的：鼻咽癌的发病年龄呈双峰分布。与成年变种不同，人们对幼年变种知之甚少。这项研究考察了成人鼻咽癌(ANPC)和青少年鼻咽癌(JNPC)患者之间的治疗结果，为jNPC未来的治疗考虑。方法和材料：jNPC人群包括1972-2004年间在两个机构接受治疗的53名患者。ANPC人群包括在一家机构接受治疗的84名患者。这些患者接受了66Gy外照射，72%的患者接受了化疗。存活患者的平均随访期为12.6年(JNPC)和6.6年(ANPC)。结果：JNPC患者比ANPC患者具有更多的进展期(92%对67%的IH-IV期，p=.006)。然而，jNPC患者的总体生存(OS)明显好于aNPC患者。5年OS率JNPC为71%，ANPC为58%(p=0.03)。JNPC组也显示出比aNPC组更大的无复发存活率(5年无复发存活率，69%比49%；p=.056)。失败模式分析显示，JNPC患者具有更好的局部控制性和无转移能力，但差异无统计学意义。对OS的单因素分析显示，年龄组、淋巴结分类和化疗用法是显著的预后因素。在调整N分类和治疗后，年龄组在多变量分析中对OS仍有显著意义。结论：尽管JNPC患者的临床表现处于较高的晚期，但其生存率高于ANPC患者。未来的治疗策略应考虑到这些年轻患者的长期并发症。(C)2009年爱思唯尔公司。
Purpose: Nasopharyngeal carcinoma (NPC) has a bimodal age distribution. In contrast to the adult variant, little is known about the juvenile form. This study examined the treatment results between adult (aNPC) and juvenile NPC (jNPC) patients for future treatment considerations in jNPC.Methods and Materials: The jNPC population included 53 patients treated at two institutions between 1972 and 2004. The aNPC population included 84 patients treated at one institution. The patients had received a median dose of 66 Gy of external beam radiotherapy and 72% underwent chemotherapy. The mean follow-up for surviving patients was 12.6 years for jNPC and 6.6 years for aNPC.Results: The jNPC patients presented with more advance stages than did the aNPC patients (92% vs. 67% Stage IH-IV, p = .006). However, jNPC patients had significantly better overall survival (OS) than did aNPC patients. The 5-year OS rate was 71% for jNPC and 58% for aNPC (p = .03). The jNPC group also demonstrated a trend for greater relapse-free survival than the aNPC group (5-year relapse-free survival rate, 69% vs. 49%; p = .056). The pattern of failure analysis revealed that the jNPC patients had greater locoregional control and freedom from metastasis but the differences were not statistically significant. Univariate analysis for OS revealed that age group, nodal classification, and chemotherapy use were significant prognostic factors. Age group remained significant for OS on multivariate analysis, after adjusting for N classification and treatment.Conclusion: Despite more advance stage at presentation, jNPC patients had better survival than did aNPC patients. Future treatment strategies should take into consideration the long-term complications in these young patients. (C) 2009 Elsevier Inc.