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不同放化疗方案对局部晚期鼻咽癌患者早期生存结果的影响

李楠 李平

李楠, 李平. 不同放化疗方案对局部晚期鼻咽癌患者早期生存结果的影响[J]. 四川大学学报(医学版), 2020, 51(5): 702-707. doi: 10.12182/20200960107
引用本文: 李楠, 李平. 不同放化疗方案对局部晚期鼻咽癌患者早期生存结果的影响[J]. 四川大学学报(医学版), 2020, 51(5): 702-707. doi: 10.12182/20200960107
LI Nan, LI Ping. Effects of Different Chemoradiotherapy Regimens on Early Survival Outcomes in Patients with Locally Advanced Nasopharyngeal Carcinoma[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION), 2020, 51(5): 702-707. doi: 10.12182/20200960107
Citation: LI Nan, LI Ping. Effects of Different Chemoradiotherapy Regimens on Early Survival Outcomes in Patients with Locally Advanced Nasopharyngeal Carcinoma[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION), 2020, 51(5): 702-707. doi: 10.12182/20200960107

栏目: 临床医学

不同放化疗方案对局部晚期鼻咽癌患者早期生存结果的影响

doi: 10.12182/20200960107
基金项目: 四川省科技厅科技支撑计划项目(No. 2015SZ0138)资助
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Effects of Different Chemoradiotherapy Regimens on Early Survival Outcomes in Patients with Locally Advanced Nasopharyngeal Carcinoma

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  • 摘要:   目的  比较局部晚期鼻咽癌患者采用EPF(表柔吡星、顺铂及氟尿嘧啶)诱导化疗联合CNRT(放疗同步尼妥珠单抗)方案或DPF(多西他赛、顺铂及氟尿嘧啶)诱导化疗联合CCRT(同步放化疗)方案的早期生存结果差异。  方法  收集2010年3月−2017年9月我院收治的局部晚期鼻咽癌(Ⅲ期至Ⅳb期)患者,主要研究终点为无疾病生存(disease-free survival, DFS),次要研究终点包括远处无转移生存(distant metastasis-free survival, DMFS)、局部无复发生存(local recurrence-free survival, LRFS)、总生存(overall survival, OS)以及治疗相关不良反应。采用倾向性评分匹配平衡两组间临床特征的差异。采用Kaplan-Meier法和log-rank检验比较两组的生存差异。采用多因素Cox比例风险模型筛选潜在的独立预后因素。  结果  经匹配后,共纳入153例患者,其中EPF联合CNRT组51例,DPF联合CCRT组102例。在2年无进展生存(82.4% vs. 85.3%,P=0.880)、LRFS(100.0% vs. 92.1%,P=0.278)、DMFS(82.3% vs. 88.2%,P=0.120)、OS(88.2% vs. 96.0%,P=0.410)方面,EPF联合CNRT组与DPF联合CCRT组相比无明显差异。治疗方案(EPF联合CNRT与DPF联合CCRT)不是DFS的独立预后因素。亚组分析中,在T3〔风险比(hazard ratio, HR)=0.174,95%置信区间0.031~0.959,P=0.045〕、N1/N2HR=0.432,95%置信区间0.197~0.946,P=0.036)、男性(HR=0.437,95%置信区间0.195~0.978, P=0.044)人群中,EPF联合CNRT方案相较于DPF联合CCRT方案可减少病情进展风险。同步放疗期间,在3~4级中性粒细胞减少方面,EPF联合CNRT组较DPF联合CCRT组发生率低(P=0.007)。  结论  与DPF联合CCRT方案相比,EPF联合CNRT方案可带来相似的生存获益,但T3、N1/N2、男性局部晚期鼻咽癌患者可能从EPF联合CNRT治疗方案中获益,且耐受性良好。
  • 图  1  EPF联合CNRT组与DPF联合CCRT组生存曲线比较

    DFS: Disease-free survival; OS: Overall survival; DMFS: Distant metastasis-free survival; LRFS: Local recurrence-free survival.

    Figure  1.  Comparison of survival curves between EPF+CNRT group and DPF+CCRT group

    表  1  患者基本特征

    Table  1.   Demographic characteristics of patients

    CharacteristicEPF+CNRT group (n=51)/case (%)DPF+CCRT group (n=102)/case (%)P
    Age/yr.0.907
     <4520 (39.21)41 (40.20)
     ≥4531 (61.78)61 (59.80)
    Gender0.903
     Male34 (66.67)69 (67.65)
     Female17 (33.33)33 (32.35)
    T stage0.653
     T110 (19.61)21 (20.59)
     T214 (27.45)19 (18.63)
     T313 (25.49)31 (30.39)
     T414 (27.45)31 (30.39)
    N stage0.661
     N15 (9.80)10 (9.80)
     N239 (74.47)72 (70.59)
     N37 (13.73)20 (19.61)
    TNM stage0.557
     Ⅲ33 (64.71)61 (59.80)
     Ⅳa/Ⅳb18 (35.29)41 (40.20)
    下载: 导出CSV

    表  2  EPF联合CNRT组与DPF联合CCRT组1年、2年生存分析结果

    Table  2.   1-year and 2-year survival analysis of EPF+CNRT group and DPF+CCRT group

    ItemEPF+CNRT group (n=51)DPF+CCRT group (n=102)
    DFS/%
     1-year98.092.2
     2-year82.485.3
    LRFS/%
     1-year100.096.1
     2-year100.092.1
    DMFS/%
     1-year98.394.1
     2-year82.388.2
    OS/%
     1-year100.099.0
     2-year88.296.0
    下载: 导出CSV

    表  3  不同亚组中治疗方案对DFS的影响

    Table  3.   Effects of treatment regimens on DFS in different subgroups

    CharacteristicEPF+CNRT group (n=51)DPF+CCRT group (n=102)HR (95%CI)P
    Age/yr.
     ≥4531520.533 (0.227-1.247)0.147
     <4520260.594 (0.185-1.902)0.380
    Gender
     Male34690.437 (0.195-0.978)0.044
     Female17331.034 (0.259-4.138)0.962
    T stage
     T110210.664 (0.110-4.019)0.656
     T214191.981 (0.384-10.224)0.414
     T313310.174 (0.031-0.959)0.045
     T414310.426 (0.150-1.213)0.110
    N stage
     N1/N244820.432 (0.197-0.946)0.036
     N37200.486 (0.219-1.080)0.076
    TNM stage
     Ⅲ33610.516 (0.185-1.444)0.208
     Ⅳa/Ⅳb18410.549 (0.217-1.384)0.204
    下载: 导出CSV

    表  4  影响DFS的多因素Cox回归分析

    Table  4.   The multivariate analysis of Cox proportional hazard model (DFS)

    FactorHR95%CIP
    Age (<45 yr. vs. ≥45 yr.)1.2840.621-2.6550.500
    Gender (male vs. female)1.2130.562-2.6170.622
    T stage
     T11 (ref)
     T20.9240.301-2.8350.890
     T30.5690.177-1.8270.343
     T41.3810.510-3.7420.525
    N stage
     N11 (ref)
     N23.2290.415-25.1320.263
     N35.2810.608-45.8870.131
    Treatment (EPF+CNRT vs. DPF+CCRT)0.5300.263-1.0660.075
    下载: 导出CSV

    表  5  EPF联合CNRT组及DPF联合CCRT组3~4级不良事件发生率

    Table  5.   Incidence of grade 3-4 adverse events in EPF+CNRT group and DPF+CCRT group

    ItemTotal (n=153)/case (%)EPF+CNRT group (n=51)/case (%)DPF+CCRT group (n=102)/case (%)P
    During induction chemotherapy
     Neutropenia19 (12.4)5 (9.8)14 (13.7)0.488
     Thrombocytopenia5 (3.3)1 (2.0)4 (3.9)0.665
     Liver function damage2 (1.3)0 (0.0)2 (2.0)0.553
    During concurrent radiotherapy
     Neutropenia23 (15.0)2 (3.9)21 (20.6)0.007
     Thrombocytopenia3 (1.9)0 (0.0)3 (2.9)0.551
     Liver function damage0 (0.0)0 (0.0)0 (0.0)
    下载: 导出CSV
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出版历程
  • 收稿日期:  2019-10-17
  • 修回日期:  2020-03-05
  • 刊出日期:  2020-09-22

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