Minimally invasive surgery alone compared with intensity-modulated radiotherapy for primary stage I nasopharyngeal carcinoma
Minimally invasive surgery alone compared with intensity-modulated radiotherapy for primary stage I nasopharyngeal carcinoma
复制标题
单纯微创手术与调强放疗治疗I期鼻咽癌的比较
DOI：
10.1186/s40880-019-0415-3
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发表时间：
2019-11-15
影响因子：
16.2
通讯作者：
Chen, Ming-Yuan
中科院分区：
文献类型：
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作者：
Liu, You-Ping;Lv, Xing;Chen, Ming-Yuan
摘要 背景 美国国家综合癌症网络指南推荐调强放射治疗（IMRT）作为新诊断鼻咽癌（NPC）的主要治疗方法，但放射相关的并发症和相对较高的医疗费用仍然给患者带来了巨大的负担。内镜鼻咽切除术（ENPG）已成功应用于复发性鼻咽癌，且无辐射且医疗费用相对较低。在这项研究中，我们研究了 ENPG 是否可以有效治疗局部 I 期鼻咽癌。方法 2007年6月至2017年9月中山大学肿瘤防治中心收治的10例新诊断局限性I期鼻咽癌患者自愿单独接受ENPG治疗。同时，收集了329例接受IMRT治疗的I期鼻咽癌患者的数据并用作参考队列。比较两组之间的生存结果、生活质量（QOL）和医疗费用。结果 中位随访 59.0 个月（95% CI 53.4-64.6）后，10 名接受 ENPG 治疗的患者未观察到死亡、局部复发或远处转移。 ENPG治疗组患者的5年总生存率、局部无复发生存率、区域无复发生存率和无远处转移生存率与IMRT治疗组相似（分别为100% vs. 99.1%、100% vs. 97.7%、100% vs. 99.0%、100% vs. 97.4%，P>0.05）。此外，与IMRT相比，ENPG与总医疗费用降低（4090.42±1502.65vs.12620.88±4242.65，P<0.001）和改善的生活质量评分相关，包括口干（3.3±10.5vs.34.4±25.8，P<0.001）和粘性唾液（3.3±10.5）与 32.6±23.3，P < 0.001）。结论 单独使用 ENPG 与有希望的长期生存结果、较低的医疗成本和令人满意的生活质量相关，因此可能是治疗拒绝放疗的新诊断局部 I 期鼻咽癌患者的替代策略。但ENPG的应用应谨慎，还需前瞻性临床试验进一步验证结果。
Abstract Background The National Comprehensive Cancer Network guidelines recommend intensity-modulated radiotherapy (IMRT) as the primary curative treatment for newly diagnosed nasopharyngeal carcinoma (NPC), but the radiation-related complications and relatively high medical costs remain a consequential burden for the patients. Endoscopic nasopharyngectomy (ENPG) was successfully applied in recurrent NPC with radiation free and relatively low medical costs. In this study, we examined whether ENPG could be an effective treatment for localized stage I NPC. Methods Ten newly diagnosed localized stage I NPC patients voluntarily received ENPG alone from June 2007 to September 2017 in Sun Yat-sen University Cancer Center. Simultaneously, the data of 329 stage I NPC patients treated with IMRT were collected and used as a reference cohort. The survival outcomes, quality of life (QOL), and medical costs between two groups were compared. Results After a median follow-up of 59.0 months (95% CI 53.4–64.6), no death, locoregional recurrence, or distant metastasis was observed in the 10 patients treated with ENPG. The 5-year overall survival, local relapse-free survival, regional relapse-free survival, and distant metastasis-free survival among the ENPG-treated patients was similar to that among the IMRT-treated patients (100% vs. 99.1%, 100% vs. 97.7%, 100% vs. 99.0%, 100% vs. 97.4%, respectively, P> 0.05). In addition, compared with IMRT, ENPG was associated with decreased total medical costs (4090.42±1502.65vs. 12620.88±4242.65, P< 0.001) and improved QOL scores including dry mouth (3.3±10.5 vs. 34.4±25.8, P< 0.001) and sticky saliva (3.3±10.5 vs. 32.6±23.3, P< 0.001). Conclusions ENPG alone was associated with promising long-term survival outcomes, low medical costs, and satisfactory QOL and might therefore be an alternative strategy for treating newly diagnosed localized stage I NPC patients who refused radiotherapy. However, the application of ENPG should be prudent, and prospective clinical trials were needed to further verify the results.