调强放疗鼻咽癌患者UICC第7版与第8版T分期预后差异

国际肿瘤学杂志››2021,Vol. 48››Issue (9): 515-522.doi:10.3760/cma.j.cn371439-20201214-00100

调强放疗鼻咽癌患者UICC第7版与第8版T分期预后差异

陈方明¹, 蔡园园², 李晗³, 王晓丽², 阚红星⁴, 李洋², 郝福荣²(), 王明臣²()

¹山东省威海市荣成市人民医院放疗科 264300
²山东省潍坊市人民医院放疗科潍坊市放射物理与肿瘤放射生物学重点实验室 261041
³山东省淄博市第四人民医院肿瘤科255022
⁴山东省烟台毓璜顶医院放疗科 264001

收稿日期:2020-12-14修回日期:2021-01-09出版日期:2021-09-08发布日期:2021-09-22
通讯作者:郝福荣,王明臣 E-mail:hkc515@163.com;flk2291@163.com
基金资助:
潍坊市科技发展计划(2019YX003)

Prognostic differences of nasopharyngeal carcinoma patients treated with intensity-modulated radiothe-rapy with different T staging of the seventh and eighth edition of the UICC staging system

Chen Fangming¹, Cai Yuanyuan², Li Han³, Wang Xiaoli², Kan Hongxing⁴, Li Yang², Hao Furong²(), Wang Mingchen²()

¹Department of Radiation Oncology, Rongcheng People's Hospital of Weihai City of Shandong Province, Weihai 264300, China
²Department of Radiation Oncology, Weifang People's Hospital of Shandong Province, Weifang Key Laboratory of Radiophysics and Oncological Radiobiology, Weifang 261041, China
³Department of Oncology, Fourth People's Hospital of Zibo City of Shandong Province, Zibo 255022, China
⁴Department of Radiation Oncology, Yantai Yuhuangding Hospital of Shandong Province, Yantai 264001, China

Received:2020-12-14Revised:2021-01-09Online:2021-09-08Published:2021-09-22
Contact:Hao Furong,Wang Mingchen E-mail:hkc515@163.com;flk2291@163.com
Supported by:
Science and Technology Development Project of Weifang City of Shandong Province of China(2019YX003)

摘要/Abstract

摘要：

目的比较调强放疗鼻咽癌在国际抗癌联盟(UICC)鼻咽癌第7版(简称UICC 7版)与第8版(简称UICC 8版)T分期的人群分布和预后差异,并分析鼻咽癌患者的预后影响因素。方法回顾性分析2005年6月1日至2017年12月31日山东省潍坊市人民医院放疗科收治的184例初治调强放疗鼻咽癌患者的临床病理资料,按UICC 7版、UICC 8版对入组病例进行重新分期,分析两版分期系统患者T分期的分布,采用Kappa一致性检验比较两种分期的一致性。采用Kaplan-Meier法进行生存分析,log-rank检验比较各T分期之间的预后差异。采用Cox回归模型分析鼻咽癌患者的预后影响因素。结果184例调强放疗鼻咽癌患者按UICC 7版T分期,T₁、T₂、T₃和T₄期分别占18.5%(34/184)、16.8%(31/184)、15.2%(28/184)、49.5%(91/184),而按UICC 8版T分期,分别占18.5%(34/184)、34.2%(63/184)、30.4%(56/184)和16.8%(31/184),两版分期系统的T分期人群分布具有中度一致性(Kappa=0.58)。UICC 7版分期中,T₁、T₂、T₃、T₄期患者的总生存期(OS)差异有统计学意义(χ²=10.606,P=0.014),T₁与T₂、T₃、T₄期患者的OS差异均有统计学意义(χ²=4.866,P=0.027;χ²=11.965,P=0.001;χ²=4.351,P=0.037),T₂、T₄期OS曲线不能分离,T₃、T₄期OS曲线倒序分布;UICC 8版分期中,4期患者的OS差异有统计学意义(χ²=8.663,P=0.034),T₁与T₃、T₄期患者的OS差异均有统计学意义(χ²=8.746,P=0.003;χ²=7.580,P=0.006),T₁~T₄期的OS曲线顺序分布,T₃与T₄期OS曲线仍未能分离。UICC 7版分期中,T₁、T₂、T₃、T₄期患者的无进展生存期(PFS)差异有统计学意义(χ²=11.289,P=0.010),T₁与T₂、T₃、T₄期患者的PFS差异均有统计学意义(χ²=8.209,P=0.004;χ²=13.302,P<0.001;χ²=6.550,P=0.010),T₂、T₄期PFS曲线不能分离,T₃、T₄期PFS曲线倒序分布;UICC 8版分期中,4期患者的PFS差异有统计学意义(χ²=12.074,P=0.007),T₁与T₂、T₃、T₄期患者的PFS差异均有统计学意义(χ²=5.182,P=0.023;χ²=11.217,P=0.001;χ²=10.174,P=0.001),T₁~T₄期的PFS曲线顺序分布,但T₃与T₄期PFS曲线未能分离。分别按UICC 7版和8版分期行Cox多因素分析,结果显示两版分期中T分期均是患者OS(P=0.013;P=0.026)、PFS(P=0.031;P=0.012)的独立预后因素,但两版分期中T分期均不是患者无局部复发生存期(LRFS)(P=0.351;P=0.167)、无远处转移生存期(DMFS)(P=0.059;P=0.052)的独立预后因素;两版分期中年龄均是影响OS(HR=2.70,95%CI为1.53~4.76,P=0.001;HR=2.74,95%CI为1.55~4.84,P=0.001)、PFS(HR=2.72,95%CI为1.46~5.08,P=0.002;HR=2.94,95%CI为1.57~5.52,P=0.001)、LRFS(HR=5.87,95%CI为1.62~21.27,P=0.007;HR=6.02,95%CI为1.61~22.49,P=0.008)及DMFS(HR=2.40,95%CI为1.22~4.72,P=0.011;HR=2.63,95%CI为1.34~5.18,P=0.005)的独立预后因素,N分期是影响OS(P=0.031;P=0.028)的独立预后因素。结论UICC 7版与8版分期系统的T分期人群分布具有中等一致性,UICC 8版T分期对OS及PFS的预后判断更有优势,两版分期中T分期均是患者OS、PFS的独立预后因素。

关键词:鼻咽肿瘤,放射疗法,肿瘤分期,预后

Abstract:

ObjectiveTo compare the differences in population distribution and prognosis of patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT) in T staging of the Union for International Cancer Control (UICC) 7th edition and UICC 8th edition, and to analyze the prognostic factors in patients with NPC.MethodsThe clinicopathologic date of 184 patients with newly diagnosed NPC treated with IMRT at the Department of Radiation Oncology of Weifang People's Hospital of Shandong Province from June 1, 2005 to December 31, 2017 were retrospectively analyzed. All patients were restaged according to the 7th and 8th edition of the UICC staging system. The distribution of T staging of patients in the two staging systems was analyzed, and the consistency of the two staging systems was compared using the Kappa consistency test. Kaplan-Meier method was used for survival analysis, and log-rank test was used to compare the prognostic differences among T stages. Cox regression model was used to analyze the prognostic factors of patients with NPC.ResultsOf all 184 patients with NPC, stage T₁, T₂, T₃and T₄respectively accounted for 18.5% (34/184), 16.8% (31/184), 15.2% (28/184) and 49.5% (91/184) according to the 7th edition UICC staging system. However, stage T₁, T₂, T₃and T₄respectively accounted for 18.5% (34/184), 34.2% (63/184), 30.4% (56/184) and 16.8% (31/184) according to the 8th edition UICC staging system. The T staging population distribution of the two staging systems showed moderate consistency (Kappa=0.58). There was a statistically significant difference in overall survival (OS) among patients with stage T₁, T₂, T₃, T₄according to the 7th edition UICC staging system (χ²=10.606,P=0.014). There were statistically significant differences in OS between stage T₁and stage T₂, T₃, T₄(χ²=4.866,P=0.027;χ²=11.965,P=0.001;χ²=4.351,P=0.037). The OS curves of stage T₂and T₄could not be separated. Moreover, the OS curves of stage T₃and T₄were distributed in reverse order. There was a statistically significant difference in OS among patients with stage T₁, T₂, T₃, T₄according to the 8th edition staging system (χ²=8.663,P=0.034). There were statistically significant differences in OS between stage T₁and stage T₃, T₄(χ²=8.746,P=0.003;χ²=7.580,P=0.006). The OS curves of stage T₁to T₄were distributed in order, but the curves of stage T₃and T₄could not be separated. There was a statistically significant difference in progression-free survival (PFS) among patients with stage T₁, T₂, T₃, T₄according to the 7th edition UICC staging system (χ²=11.289,P=0.010). There were statistically significant differences in PFS between stage T₁and stage T₂, T₃, T₄(χ²=8.209,P=0.004;χ²=13.302,P<0.001;χ²=6.550,P=0.010). The PFS curves of stage T₂and T₄could not be separated. Moreover, the PFS curves of stage T₃and T₄were distributed in reverse order. There was a statistically significant difference in PFS among patients with stage T₁, T₂, T₃, T₄according to the 8th edition staging system (χ²=12.074,P=0.007). There were statistically significant differences in PFS between stage T₁and stage T₂, T₃, T₄(χ²=5.182,P=0.023;χ²=11.217,P=0.001;χ²=10.174,P=0.001). The PFS curves of stage T₁to T₄were distributed in order, but the curves of stage T₃and T₄could not be separated. The results of Cox multivariate analysis showed that T staging of both staging systems were the independent prognostic factors of the OS (P=0.013;P=0.026) and PFS (P=0.031;P=0.012). However, T staging of the two editions were not the independent prognostic factors of the local recurrence-free survival (LRFS) (P=0.351;P=0.167) and distant metastasis-free survival (DMFS) (P=0.059;P=0.052). The age was the independent prognostic factor of the OS (HR=2.70, 95%CI: 1.53-4.76, P=0.001; HR=2.74, 95%CI: 1.55-4.84, P=0.001), PFS (HR=2.72, 95%CI: 1.46-5.08,P=0.002;HR=2.94, 95%CI: 1.57-5.52,P=0.001), LRFS (HR=5.87, 95%CI: 1.62-21.27,P=0.007;HR=6.02, 95%CI: 1.61-22.49,P=0.008) and DMFS (HR=2.40, 95%CI: 1.22-4.72,P=0.011;HR=2.63, 95%CI: 1.34-5.18,P=0.005). N staging was the independent prognostic factor of the OS (P=0.031;P=0.028).ConclusionThe T staging population distribution of the 7th and 8th edition UICC staging system had moderate consistency, and the T staging of the 8th edition is more advantageous in predicting the prognosis of OS and PFS. In both editions, T staging is an independent prognostic factor for OS and PFS.

Key words:Nasopharyngeal neoplasms,Radiotherapy,Neoplasm staging,Prognosis

陈方明, 蔡园园, 李晗, 王晓丽, 阚红星, 李洋, 郝福荣, 王明臣. 调强放疗鼻咽癌患者UICC第7版与第8版T分期预后差异[J]. 国际肿瘤学杂志, 2021, 48(9): 515-522.

Chen Fangming, Cai Yuanyuan, Li Han, Wang Xiaoli, Kan Hongxing, Li Yang, Hao Furong, Wang Mingchen. Prognostic differences of nasopharyngeal carcinoma patients treated with intensity-modulated radiothe-rapy with different T staging of the seventh and eighth edition of the UICC staging system[J]. Journal of International Oncology, 2021, 48(9): 515-522.

图/表6

一般临床特征	例(%)	一般临床特征	例(%)
男	136(73.9)	角化型鳞状细胞癌	22(12.0)
女	48(26.1)
年龄(岁)		非角化型鳞状细胞癌	162(88.0)
<54	97(52.7)
≥54	87(47.3)	N分期
治疗方案		N₀	11(6.0)
单纯放疗	62(33.7)	N₁	60(32.6)
同步放化疗	60(32.6)	N₂	86(46.7)
非同步联合放化疗	62(33.7)	N₃	27(14.7)

表1

UICC 7版分期	UICC 8版分期	合计
T₁	34(18.5)	0(0)	0(0)	0(0)	34(18.5)
T₂	0(0)	31(16.8)	0(0)	0(0)	31(16.8)
T₃	0(0)	0(0)	28(15.2)	0(0)	28(15.2)
T₄	0(0)	32(17.4)	28(15.2)	31(16.8)	91(49.5)
合计	34(18.5)	63(34.2)	56(30.4)	31(16.8)	184(100.00)

表2

图1

图2

表3

184例调强放疗鼻咽癌患者UICC 7版分期多因素预后分析"

因素	OS				PFS				LRFS				DMFS
因素	HR值	95%CI	P值		HR值	95%CI	P值		HR值	95%CI	P值		HR值	95%CI	P值
年龄(岁)
<53	参照	-	-	参照		-	-	参照		-	-	参照		-	-
≥53	2.70	1.53~4.76	0.001	2.72		1.46~5.08	0.002	5.87		1.62~21.27	0.007	2.40		1.22~4.72	0.011
性别
男	参照	-	-	参照		-	-	参照		-	-	参照		-	-
女	1.30	0.71~2.40	0.399	1.30		0.67~2.52	0.442	2.06		0.63~6.71	0.233	1.32		0.64~2.69	0.454
T分期			0.013				0.031				0.351				0.059
T₁	参照	-	-	参照		-	-	-		-	-	参照		-	-
T₂	2.35	0.82~6.72	0.111	6.75		1.48~30.76	0.014	0.15		0.02~1.34	0.089	6.71		1.47~30.60	0.014
T₃	5.76	1.95~17.06	0.002	10.11		2.17~47.05	0.003	1.40		0.32~6.09	0.656	7.27		1.50~35.27	0.014
T₄	2.63	0.99~6.99	0.052	6.04		1.39~26.37	0.017	参照		-	-	4.39		0.99~19.40	0.051
N分期			0.031				0.430				0.917				0.383
N₀	参照	-	-	参照		-	-	参照		-	-	参照		-	-
N₁	4.71	1.00~22.15	0.050	1.33		0.33~5.30	0.688	0.85		0.11~6.78	0.875	1.24		0.24~6.43	0.796
N₂	5.31	1.12~25.22	0.036	1.69		0.43~6.59	0.454	1.28		0.17~9.97	0.813	1.74		0.35~8.71	0.500
N₃	9.07	1.89~43.54	0.006	2.41		0.60~9.68	0.214	1.43		0.13~15.40	0.767	2.53		0.50~12.90	0.263
因素	OS				PFS				LRFS				DMFS
因素	HR值	95%CI	P值		HR值	95%CI	P值		HR值	95%CI	P值		HR值	95%CI	P值
治疗方案			0.028				0.600				0.285				0.681
单纯放疗	参照	-	-	参照		-	-	参照		-	-	参照		-	-
同步放化疗	0.55	0.30~1.03	0.063	0.86		0.42~1.74	0.674	0.97		0.29~3.28	0.956	1.11		0.51~2.41	0.798
非同步放化疗	0.43	0.22~0.84	0.013	0.68		0.33~1.43	0.313	0.28		0.05~1.52	0.140	0.78		0.34~1.79	0.564
病理类型
角化型鳞状细胞癌	参照	-	-	参照		-	-	参照		-	-	参照		-	-
非角化鳞状细胞癌	0.85	0.40~1.80	0.675	0.98		0.42~2.25	0.955	0.80		0.20~3.22	0.756	1.37		0.47~3.97	0.565

表3

表4

184例调强放疗鼻咽癌患者UICC 8版分期多因素预后分析"

因素	OS				PFS				LRFS				DMFS
因素	HR值	95%CI	P值		HR值	95%CI	P值		HR值	95%CI	P值		HR值	95%CI	P值
年龄(岁)
<53	参照	-	-	参照		-	-	参照		-	-	参照		-	-
≥53	2.74	1.55~4.84	0.001	2.94		1.57~5.52	0.001	6.02		1.61~22.49	0.008	2.63		1.34~5.18	0.005
性别
男	参照	-	-	参照		-	-	参照		-	-	参照		-	-
女	1.24	0.68~2.28	0.484	1.28		0.66~2.47	0.471	1.75		0.52~5.90	0.367	1.31		0.64~2.67	0.463
T分期			0.026				0.012				0.167				0.052
T₁	参照	-	-	参照		-	-	-		-	-	参照		-	-
T₂	2.18	0.81~5.89	0.125	5.11		1.16~22.52	0.031	0.37		0.07~2.08	0.259	4.33		0.97~19.27	0.055
T₃	4.25	1.53~11.83	0.006	10.11		2.22~44.28	0.003	2.08		0.50~8.70	0.314	6.73		1.47~30.77	0.014
T₄	3.58	1.22~10.52	0.020	6.04		1.95~42.44	0.005	参照		-	-	7.80		1.65~36.89	0.010
N分期			0.028				0.443				0.972				0.393
N₀	参照	-	-	参照		-	-	参照		-	-	参照		-	-
N₁	3.75	0.82~17.17	0.089	1.37		0.35~5.29	0.652	0.94		0.12~7.17	0.953	1.28		0.26~6.40	0.763
N₂	3.91	0.85~17.91	0.079	1.47		0.40~5.47	0.565	1.28		0.19~8.60	0.797	1.50		0.31~7.20	0.612
N₃	7.92	1.67~37.58	0.009	2.39		0.61~9.40	0.212	1.23		0.13~11.58	0.859	2.54		0.51~12.71	0.256
治疗方案			0.054				0.801				0.603				0.928
单纯放疗	参照	-	-	参照		-	-	参照		-	-	参照		-	-
同步放化疗	0.53	0.28~1.00	0.051	0.82		0.41~1.67	0.589	0.96		0.27~3.43	0.954	1.04		0.48~2.25	0.929
非同步放化疗	0.49	0.25~0.96	0.039	0.79		0.37~1.69	0.544	0.44		0.08~2.42	0.346	0.89		0.38~2.08	0.789
病理类型
角化型鳞状细胞癌	参照	-	-	参照		-	-	参照		-	-	参照		-	-
非角化鳞状细胞癌	0.88	0.42~1.88	0.748	1.10		0.47~2.55	0.827	1.01		0.25~4.14	0.991	1.54		0.53~4.48	0.429

表4

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