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背景与目的:调强放射治疗可以明显提高鼻咽癌的局部控制率,使T分期的预后价值发生改变。本文拟评价接受调强放射治疗的鼻咽癌患者国际抗癌联盟(Union for International Cancer Control,UICC)第7版分期中T分期的预后价值,并对其简化方式进行探讨。方法:回顾浙江省肿瘤医院放疗科2007年1月—2011年6月收治的641例初治鼻咽癌患者的基本资料,采用Kaplan-Meier法及COX回归评价UICC第7版分期中T分期的预后价值。结果:641例患者的5年总生存率(overall survival,OS)、无局部复发生存率(loco-relapse free survival,LRFS)、无进展生存率(progression-free survival,PFS)和无远处转移生存率(distant metastasis free survival,DMFS)分别为85.4%、88.5%、78%和87.1%,其中T_1、T_2、T_3和T_4分期患者的5年OS分别为91.6%、85.3%、90.1%和76.5%,LRFS为93%、85.3%、91.5%和84.4%,PFS为88.2%、77.3%、80.8%和70.9%,DMFS为95.1%、88.9%、88.2%和81.3%。其中T_1、T_2和T_3期的各指标间差异无统计学意义,而T_4期与T_1、T_2和T_3期之间多个预后指标差异均有统计学意义(P<0.05)。将T_1、T_2和T_3期合并为新T_1期,T_4期为新T_2期。新T_1和T_2期的5年OS为89.1%和76.5%(P=0.001);LRFS为90.1%和84.4%(P=0.028);PFS为81%和70.9%(P=0.001);DMFS为90.8%和81.2%(P=0.002),差异均有统计学意义。在不同的N分期中分别分析,简化的T分期仍有明显的预后预测优势。结论:在调强放射治疗时代,UICC第7版分期中的T分期之间的预后差异不明显,简化T分期能更好地适应治疗方法的改革和预测预后。
BACKGROUND & OBJECTIVE: IMRT can significantly improve the local control rate of nasopharyngeal carcinoma and change the prognostic value of T staging. This article is intended to evaluate the prognostic value of staging T stage in the seventh edition of the Union for International Cancer Control (UICC) in patients with radiation-modulated nasopharyngeal carcinoma (NPC) and to discuss its simplified approach. Methods: The basic data of 641 newly diagnosed nasopharyngeal carcinoma patients admitted to Department of Radiation Oncology, Zhejiang Cancer Hospital from January 2007 to June 2011 were retrospectively analyzed. The Kaplan-Meier method and COX regression were used to evaluate the T stage of UICC Prognostic value. Results: The 5-year overall survival (OS), locoregional relapse free survival (LRFS), progression-free survival (PFS) and distant metastasis The 5-year OS of T_1, T_2, T_3 and T_4 patients were 91.6%, 85.3%, 90.1% and 76.5%, respectively. The survival rates were 85.4%, 88.5%, 78% and 87.1% The LRFS was 93%, 85.3%, 91.5% and 84.4%, PFS was 88.2%, 77.3%, 80.8% and 70.9%, DMFS was 95.1%, 88.9%, 88.2% and 81.3%, respectively. Among them, there was no significant difference between T_1, T_2 and T_3, but there were significant differences between T_4 and T_1, T_2 and T_3 (P <0.05). T_1, T_2 and T_3 will be merged into new T_1 and T_4 will be new T_2. The 5-year OS was 89.1% and 76.5% in the new T_1 and T_2 phases (P = 0.001); LRFS was 90.1% and 84.4% (P = 0.028); PFS was 81% and 70.9% (P = 0.001) % And 81.2% (P = 0.002), the differences were statistically significant. In different N staging analysis, the simplified T staging still has obvious prognostic advantages. Conclusions: In the era of IMRT, there is no obvious difference in prognosis between the T stage and the staging of UICC. The simplified T staging can better adapt to the reform of the treatment method and predict the prognosis.