Another way to estimate outcome of advanced nasopharyngeal carcinoma - Is concurrent chemoradiotherapy adequate?
Another way to estimate outcome of advanced nasopharyngeal carcinoma - Is concurrent chemoradiotherapy adequate?
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DOI：
10.1016/j.ijrobp.2004.03.002
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发表时间：
2004-09-01
影响因子：
7
通讯作者：
Lin, AC
中科院分区：
文献类型：
--
作者：
Lin, JC;Liang, WM;Lin, AC
目的：评估简单的风险分组系统并确定同步放化疗（CCRT）是否适合晚期鼻咽癌（NPC）患者。方法和材料：对1992年美国癌症联合委员会（AJCC）III至IV期（MO）鼻咽癌患者共284例进行回顾性分析。他们接受单独放疗 (RT) 或 CCRT 治疗。我们根据我们的经验将患者分为高风险和低风险亚组。高危患者至少满足以下标准之一：（I）淋巴结大小> 6 cm，（2）锁骨上淋巴结转移，（3）1992 AJCC T4N2分期，（4）多发颈部淋巴结转移，其中1个淋巴结> 4 cm。每个患者的疾病程度根据我们的风险分组系统、AJCC 1992 和 1997 分期系统进行分层。对这三种不同分类之间的生存分析——包括鼻咽无病（TS）、颈部无病（NS）、远处转移无病（MS）、总生存（OS）和无进展（PFS）生存曲线进行比较。结果：根据1992年AJCC分期系统，80.3%（228/284）的鼻咽癌患者处于IV期，而只有19.7%处于III期。大多数患者按 1997 年 AJCC 分期系统降级，其中 28.5% (81/284) 为 IV 期，71.5% (203/284) 为 III/II 期。我们的风险标准对患者分布进行了更均匀的分层，因为 119 名患者 (41.9%) 被分配到高风险组，165 名患者 (58.1%) 被分配到低风险组。 Kaplan-Meier 生存曲线的对数秩检验、Cox 比例风险模型的多变量比较以及 3 个拟合优度指数验证了我们的风险分组系统似乎至少与 1992 年和 1997 年 AJCC 系统一样有效，或略优于 1997 年 AJCC 系统。 5 年 TS（95.1% vs. 76.8%，p = 0.0012）、NS（100% vs. 95.7%，p = 0.0974）、MS（90.5% vs. 78.1%，p = 0.0282）、OS（83.2% vs. 59.7%，p = 0.0041）和 PFS对于低风险组，接受 CCRT 的患者明显优于单独 RT 的患者（87.3% vs. 61.5%，p = 0.0003）。然而，CCRT 和 RT 对于高危患者的相应生存率分别为：TS 为 74.9% vs. 67.6% (p = 0.2545)，NS 为 92.1% vs. 86.8% (p = 0.4744)，MS 为 59.7% vs. 60.0% (p = 0.5537)，MS 为 55.8% vs. 46.3% OS 分别为 (p = 0.1761)，PFS 分别为 44.5% 和 43.1% (p = 0.3911)。结论：对于低风险患者，同步放化疗优于单独放疗，但对于高风险患者则不足。对于高危患者来说，添加新辅助和/或辅助化疗将是一种合理的方法。我们的风险分组标准是一个简单而有用的指南，将对未来治疗试验的设计产生重要影响。 (C) 2004 年爱思唯尔公司。
Purpose: To evaluate a simple risk grouping system and determine whether concurrent chemoradiotherapy (CCRT) is adequate for patients with advanced nasopharyngeal carcinoma (NPC).Methods and Materials: A total of 284 patients with 1992 American Joint Committee on Cancer (AJCC) Stage III to IV (MO) NPC were analyzed retrospectively. They were treated by either radiotherapy (RT) alone or CCRT. We divided patients into high-risk and low-risk subgroups according to our experience. High-risk patients met at least one of the following criteria: (I) nodal size >6 cm, (2) supraclavicular node metastases, (3) 1992 AJCC stage T4N2, (4) multiple neck node metastases with 1 node >4 cm. The disease extent of each patient was stratified by our risk grouping system, AJCC 1992 and 1997 staging systems. Survival analyses-including nasopharynx disease free (TS), neck disease free (NS), distant metastasis disease free (MS), overall survival (OS), and progression-free (PFS) survival curves-were compared between these three different classifications.Results: According to the 1992 AJCC staging system, 80.3% (228/284) of NPC patients are Stage IV, whereas only 19.7% are Stage III. Most patients are downstaged by the 1997 AJCC staging system with 28.5% (81/284) Stage IV and 71.5% (203/284) Stage III/II. Our risk criteria stratify more even patient distribution, because 119 patients (41.9%) are assigned to the high-risk group and 165 patients (58.1%) to the low-risk group. Log-rank test of Kaplan-Meier survival curves, multivariate comparison of the Cox proportional hazards model, and 3 goodness-of-fit indices validated that our risk grouping system seemed to be at least as efficacious as, or slightly superior to, the 1992 and 1997 AJCC systems. The 5-year TS (95.1% vs. 76.8%,p = 0.0012), NS (100% vs. 95.7%, p = 0.0974), MS (90.5% vs. 78.1%, p = 0.0282), OS (83.2% vs. 59.7%, p = 0.0041), and PFS (87.3% vs. 61.5%, p = 0.0003) were significantly better in patients receiving CCRT than RT alone for the low-risk group. However, the corresponding survival rates between CCRT and RT for high-risk patients were 74.9% vs. 67.6% (p = 0.2545) for TS, 92.1% vs. 86.8% (p = 0.4744) for NS, 59.7% vs. 60.0% (p = 0.5537) for MS, 55.8% vs. 46.3% (p = 0.1761) for OS, and 44.5% vs. 43.1% (p = 0.3911) for PFS, respectively.Conclusions: Concurrent chemoradiotherapy is superior to RT alone for low-risk patients but inadequate for high-risk patients. Adding neoadjuvant and/or adjuvant chemotherapy would be a reasonable approach for high-risk patients. Our risk grouping criteria are a simple and useful guide that will have important implications in the design of future therapeutic trials. (C) 2004 Elsevier Inc.