Nasopharyngeal carcinoma treated with intensity-modulated radiotherapy: clinical outcomes and patterns of failure among subsets of 8th AJCC stage IVa
Nasopharyngeal carcinoma treated with intensity-modulated radiotherapy: clinical outcomes and patterns of failure among subsets of 8th AJCC stage IVa
复制标题
鼻咽癌调强放射治疗：第 8 届 AJCC IVa 期子集的临床结果和失败模式
DOI：
10.1007/s00330-019-06500-5
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发表时间：
2019-10-24
影响因子：
5.9
通讯作者：
Tang, Ling-long
中科院分区：
文献类型：
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作者：
Huang, Cheng-Long;Guo, Rui;Tang, Ling-long
目的美国癌症联合委员会（AJCC）第8版鼻咽癌（NPC）分期系统将T4 N 0 -2和T1- 4 N3合并为Ⅳ a期。在本研究中，我们的目的是评估第八AJCC T4 N 0 -2和T1- 4 N3 NPC患者接受调强放疗（IMRT）治疗的临床结局和失败模式的差异。方法根据AJCC第8分期标准，对3107例Ⅳ a期鼻咽癌患者进行临床分期，其中T4 N 0 -2期1871例，T1- 4 N3期1236例。总生存期（OS）是主要终点。比较T4 N 0 -2和T1- 4 N3患者的临床结局。结果与T4 N 0 -2患者相比，T1- 4 N3患者的3年OS（84.1% vs. 89.2%; p < 0.001）和无远处转移生存率（DMFS; 78.3% vs. 85.9%; p < 0.001）明显更差，但局部无复发生存率（LRFS; 94.9% vs. 92.2%; p = 0.003）更好。多因素分析显示，T1- 4 N3仍是DMFS的独立不良预后因素，（风险比[HR] = 1.517，95%置信区间[CI] = 1.274-1.806，p < 0.001）和OS（HR = 1.315，95%CI = 1.100-1.572，p = 0.003），而T4 N 0 -2是LRFS的独立不良预后因素（HR = 1.581，95%CI = 1.158-2.158，p = 0.004）。结论T4 N 0 -2期患者的OS较T1- 4 N3期患者预后好，T4 N 0 -2期患者与T1- 4 N3期患者的失败模式不同。我们认为，AJCC/UICC分期系统的未来修改应将T4 N 0 -2与T1- 4 N3分开。
Objectives The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for nasopharyngeal carcinoma (NPC) merged T4N0-2 and T1-4N3 to create stage IVa. In the present study, we aimed to assess the difference in clinical outcomes and patterns of failure between 8th AJCC T4N0-2 and T1-4N3 NPC patients treated with intensity-modulated radiotherapy (IMRT). Methods We included 3107 patients with stage IVa NPC disease (1871 with T4N0-2 and 1236 with T1-4N3) according to the 8th AJCC staging system. Overall survival (OS) was the primary endpoint. The clinical outcomes between T4N0-2 and T1-4N3 patients were compared. Results T1-4N3 patients had significantly worse 3-year OS (84.1% vs. 89.2%; p < 0.001) and distant metastasis-free survival (DMFS; 78.3% vs. 85.9%; p < 0.001), but better local relapse-free survival (LRFS; 94.9% vs. 92.2%; p = 0.003), as compared with T4N0-2 patients. Multivariate analysis showed that T1-4N3 was still an independent adverse prognostic factor for both DMFS (hazard ratio [HR] = 1.517, 95% confidence interval [CI] = 1.274-1.806, p < 0.001) and OS (HR = 1.315, 95% CI = 1.100-1.572, p = 0.003), whereas T4N0-2 was an independent adverse prognostic factor for LRFS (HR = 1.581, 95% CI = 1.158-2.158, p = 0.004). Conclusions In terms of the OS, T4N0-2 patients had better prognosis compared with T1-4N3 patients, and the patterns of failure differed between T4N0-2 and T1-4N3 patients. We believe that future modifications of the AJCC/UICC staging system should separate T4N0-2 from T1-4N3.