Establishment and validation of M1 stage subdivisions for de novo metastatic nasopharyngeal carcinoma to better predict prognosis and guide treatment

被引：92

作者：

Zou, Xiong ^{[1
,2
]}

You, Rui ^{[1
,2
]}

Liu, Huai ^{[3
]}

He, Yu-Xiang ^{[4
]}

Xie, Guo-Feng ^{[5
]}

Xie, Zhi-Hai ^{[6
]}

Li, Ji-Bin ^{[2
,7
,8
]}

Jiang, Rou ^{[1
,2
]}

Liu, Li-Zhi ^{[2
,9
]}

Li, Li ^{[2
,9
]}

Zhang, Meng-Xia ^{[1
,2
]}

Liu, You-Ping ^{[1
,2
]}

Hua, Yi-Jun ^{[1
,2
]}

Guo, Ling ^{[1
,2
]}

Qian, Chao-Nan ^{[1
,2
]}

Mai, Hai-Qiang ^{[1
,2
]}

Chen, Dong-Ping ^{[5
]}

Luo, Ying ^{[3
]}

Shen, Liang-Fang ^{[4
]}

Hong, Ming-Huang ^{[2
,7
,8
]}

Chen, Ming-Yuan ^{[1
,2
]}

机构：

[1] Sun Yat Sen Univ, Dept Nasopharyngeal Carcinoma, Ctr Canc, 651 Dongfeng East Rd, Guangzhou 510060, Guangdong, Peoples R China

[2] Sun Yat Sen Univ, Collaborat Innovat Ctr Canc Med, Ctr Canc, State Key Lab Oncol South China, Guangzhou 510060, Guangdong, Peoples R China

[3] Hunan Canc Hosp, Dept Radiat Oncol, 283 Tongzipo Rd, Changsha 410000, Hunan, Peoples R China

[4] Cent S Univ, Dept Radiat Oncol, Xiangya Hosp, 87 Xiangya Rd, Changsha 410008, Hunan, Peoples R China

[5] Guangzhou Med Univ, Ctr Canc, Dept Radiat Oncol, 78 Hengzhigang, Guangzhou 510095, Guangdong, Peoples R China

[6] Cent S Univ, Xiangya Hosp, Dept Otorhinolaryngol Head & Neck Surg, 87 Xiangya Rd, Changsha 410008, Hunan, Peoples R China

[7] Sun Yat Sen Univ, Ctr Canc, Dept Clin Trials Ctr, 651 Dongfeng East Rd, Guangzhou 510060, Guangdong, Peoples R China

[8] Sun Yat Sen Univ, Ctr Canc, 651 Dongfeng East Rd, Guangzhou 510060, Guangdong, Peoples R China

[9] Sun Yat Sen Univ, Ctr Canc, Dept Med Imaging & Intervent Radiol, 651 Dongfeng East Rd, Guangzhou 510060, Guangdong, Peoples R China

来源：

EUROPEAN JOURNAL OF CANCER | 2017年 / 77卷

基金：

中国国家自然科学基金;

关键词：

Nasopharyngeal carcinoma; De novo; Distant metastasis; Subdivisions; Chemotherapy; Radiotherapy; DISTANT METASTASES; RADIATION-THERAPY; PHASE-II; SYSTEM; CHEMOTHERAPY; RADIOTHERAPY; COMBINATION; MANAGEMENT; SURVIVAL; FAILURE;

D O I：

10.1016/j.ejca.2017.02.029

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background: To better manage patients with de novo metastatic NPC (mNPC) including easily identifying individuals' survival outcomes and accurately choosing the most suitable treatment. Materials and methods: Three independent cohorts of mNPC patients (a training set of n = 462, an internal prospective validation set of n = 272 and an external prospective validation set of n = 243) were studied. The radiological characteristics of distant metastases, including number of metastatic locations, number of metastatic lesions and size of metastatic lesions, were carefully defined based on imaging data. These three factors and other potential prognostic factors were comprehensively analysed and were further integrated into new subdivisions of stage M1 using a Cox proportional hazards model. Results: We successfully subdivided the M1 stage into three categories: M1a, oligo metastasis without liver involvement; M1b, multiple metastases without liver involvement; and M1c, liver involvement irrespective of metastatic lesions. The 3-year overall survival ranged from 54.5% to 72.8%, from 34.3% to 41.6% and from 22.6.0%-23.6% for M1a, M1b and M1c, respectively (P < 0.001). Systemic chemotherapy combined with radical loco-regional radiotherapy may benefit patients in M1a and M1b, not in M1c. Further aggressive treatment of metastatic lesions based on systemic chemotherapy and definitive loco-regional radiotherapy showed no survival benefit, even for patients in M1a (P > 0.05). Conclusion: The subdividing of M1 provided promising prognostic value and could aid clinicians in choosing the most suitable treatment for de novo mNPC patients. (C) 2017 Elsevier Ltd. All rights reserved.

引用

页码：117 / 126

页数：10

共 38 条

[11]

Huang Chih-Jen, 1996, Kaohsiung Journal of Medical Sciences, V12, P229

[12] Lung metastasis alone in nasopharyngeal carcinoma: A relatively favorable prognostic group - A study by the Hong Kong nasophatyngeal carcinoma study group [J].