The prognostic influence of prevertebral space involvement in nasopharyngeal carcinoma
The prognostic influence of prevertebral space involvement in nasopharyngeal carcinoma
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DOI：
10.1111/j.1749-4486.2008.01770.x
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发表时间：
2008-10-01
影响因子：
2.1
通讯作者：
Chen, L. -F.
中科院分区：
文献类型：
--
作者：
Lee, C. -C.;Chu, S. -T.;Chen, L. -F.
目的：本研究的目的是评估鼻咽癌（NPC）患者在放疗/同步放化疗或同步放化疗配合辅助化疗治疗时，椎间隙受损伤对治疗结果的影响。设计：回顾性回顾高雄退伍军人总医院档案的病例记录。环境：台湾的一个医疗中心。参与者：新诊断的NPC病例145例。39例患者因表现时存在远处转移、随访缺失和影像信息不完整而被排除。主要观察指标：单因素分析采用Pearson卡方检验分析肿瘤侵袭与椎间隙受累的相关性，多因素分析采用logistic回归分析。构建Kaplan-Meier生存曲线。进行多变量分析以检验各种预后因素的影响。还使用Pearson卡方检验和Fisher精确检验来评估失败模式与治疗方式之间的相关性。结果：本研究共纳入106例新诊断的鼻咽癌患者。43例患者（41%）发现椎前间隙受累。与未侵犯椎前间隙的患者相比，累及椎前间隙的患者总体生存率和无转移生存率较差（P分别= 0.04和0.02）。多因素分析显示椎前间隙侵犯与远处转移风险增加相关[危险比（HR） 14, 95%可信区间（CI） 1.0-17.4；P = 0.03)]和总生存率（HR 7, 95% CI 1.1-135; P = 0.04）。累及椎前间隙的患者，有无辅助化疗的无转移生存率分别为100%和72.7% （P = 0.047）。未侵犯椎前间隙的鼻咽癌患者未见此现象。结论：椎前间隙受累与鼻咽癌患者的生存率和复发率密切相关。累及椎前间隙的鼻咽癌患者有更多的复发率和较差的生存率，应该从同步放化疗和辅助化疗中获益。包括椎前间隙受累可能需要预测鼻咽癌的预后，并帮助我们确定高危人群。
Objectives: The purpose of this study was to evaluate the effect of prevetebral space involvement on treatment outcomes in patients with nasopharyngeal carcinoma (NPC) who were treated with radiotherapy/concurrent chemoradiotherpy or concurrent chemoradiotherpy with adjuvant chemotherapy.Design: A retrospective review of case notes from the Kaohsiung Veterans General Hospital archives was performed.Setting: A medical centre in Taiwan.Participants: There were 145 newly diagnosed cases of NPC. Thirty-nine patients were excluded because of the presence of distant metastasis at the time of presentation, loss of follow-up and incomplete image information.Main outcome measures: Pearson's chi-square tests were used to analyse correlation between tumour invasion and prevetebral space involvement during univariate analysis and logistic regression was applied during multivariate analysis. Kaplan-Meier survival curves were constructed. Multivariate analysis was performed to examine the impact of various prognostic factors. Pearson's chi-square and Fisher's exact test were also used to evaluate the correlation between failure patterns and treatment modality.Results: A total of 106 patients with newly diagnosed NPC were enrolled in this study. Forty-three patients (41%) in this series were found to have prevertebral space involvement. Patients with prevertebral space involvement conferred a poor overall survival rate and metastasis-free survival rate compared with those without prevertebral space invasion (P = 0.04 and 0.02 respectively). Multivariate analysis showed that prevertebral space invasion was associated with an increased risk for distant metastasis [hazard ratio (HR) 14, 95% confidence interval (CI) 1.0-17.4; P = 0.03)] and overall survival (HR 7, 95% CI 1.1-135; P = 0.04). In patients with prevertebral space involvement, their metastasis-free survival rate, with and without adjuvant chemotherapy, was 100% and 72.7% (P = 0.047). This phenomenon was not observed in NPC patients without prevertebral space invasion.Conclusions:The present data revealed that prevertebral space involvement has a close relationship with survival rates and recurrence rates of patients with NPC. Nasopharyngeal carcinoma patients with prevertebral space involvement have more recurrence and poorer survival rates and should be the group to benefit from concurrent chemoradiotherapy followed by adjuvant chemotherapy. Inclusion of prevertebral space involvement may be needed to predict prognosis of NPC and help us to identify the high-risk group.