Proposal for a new risk classification system for nasopharyngeal carcinoma patients with post-radiation nasopharyngeal necrosis
Proposal for a new risk classification system for nasopharyngeal carcinoma patients with post-radiation nasopharyngeal necrosis
复制标题
针对鼻咽癌放射后鼻咽坏死患者建立新的风险分类系统的建议
DOI：
10.1016/j.oraloncology.2017.02.012
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发表时间：
2017-04-01
期刊：
影响因子：
4.8
通讯作者：
Chen, Ming-Yuan
中科院分区：
文献类型：
--
作者：
Yang, Qi;Zou, Xiong;Chen, Ming-Yuan
目的：分析鼻咽癌（NPC）患者放射性后鼻咽坏死（PRNN）的临床结局，构建预测PRNN生存的新风险分类系统。方法：连续纳入276例PRNN患者。所有患者均可获得鼻咽和颈部的完整磁共振（MR）图像，并用于评估鼻咽坏死状态。 2010年以后，PRNN患者最初采用根治性内镜坏死切除术，然后鼻瓣重建术（ENNF）。结果：1年和2年总生存率（OS）分别为65.0%和51.6%。三个变量影响生存：放射性骨坏死、再照射和颈内动脉（ICA）暴露，只有两个变量被发现是独立的预后因素：再照射（风险比[HR] 1.75，P = 0.001）和颈内动脉（ICA）暴露（风险比[HR] 1.80，P = 0.001）。这两个变量结合起来为 PRNN 创建了一个新的风险分类系统。低危组、中危组和高危组分别有131例（47.5%）、110例（39.9%）和35例（12.7%）患者，2年OS率分别为64.8%、45.1%和22.5%（P < 0.001）。与保守治疗相比，ENNF 与具有统计或边际统计显着性的保守治疗相比具有更好的 OS（2 年 OS 低风险组，90.9% vs 61.1%，p = 0.081；中风险组：100% vs 37.8%，P = 0.001；高风险组，57.1% vs 20.8%，p = 0.066）。新的风险分类系统提供了准确的预后估计。对于 PRNN 患者，ENNF 手术可能比保守治疗带来更好的生存结果。 (C) 2017 Elsevier Ltd. 保留所有权利。
Purpose: To analyze the clinical outcomes of nasopharyngeal carcinoma (NPC) patients with post-radiation nasopharyngeal necrosis (PRNN) and construct a new risk classification system for predicting survival of PRNN.Methods: A total of 276 patients with PRNN were consecutively enrolled. Complete magnetic resonance (MR) images of the nasopharynx and neck were available for all patients and were used to assess nasopharyngeal necrosis status. After 2010, patients with PRNN were initially treated by radical endoscopic necrectomy followed by reconstruction with nasal flap (ENNF).Results: The 1-year and 2-year overall survival (OS) was 65.0% and 51.6%, respectively. Three variables affected survival: osteoradionecrosis, re-irradiation, and internal carotid artery (ICA) exposure, and only two variables were found to be independent prognostic factors: re-irradiation (hazard ratio [HR] 1.75, P = 0.001) and internal carotid artery (ICA) exposure (hazard ratio [HR] 1.80, P = 0.001). These two variables were combined to create a new risk classification system for PRNN. 131 (47.5%), 110 (39.9%), and 35 (12.7%) patients were classified into low-, intermediate-and high-risk group, with the 2-year OS rates of 64.8%, 45.1%, and 22.5%, respectively (P < 0.001). ENNF was associated with a better OS in these three group patients compared with conservative management with statistical or marginal statistical significance (2-year OS low-risk group, 90.9% vs 61.1%, p = 0.081; intermediate-risk group: 100% vs 37.8%, P = 0.001; and high-risk group, 57.1% vs 20.8%, p = 0.066).Conclusion: The new risk classification system provides accurate estimates of prognosis. ENNF surgery may lead to better survival outcome than conservative management in PRNN patients. (C) 2017 Elsevier Ltd. All rights reserved.