| 杨春李,吴伟莉,金风,李媛媛,龙金华,罗秀玲,陈宇,唐红,张芒,翁克贵.动态增强磁共振参数与局部晚期鼻咽癌患者预后相关性的前瞻性长期随访研究[J].中华放射医学与防护杂志,2020,40(6):446-453 |
| 动态增强磁共振参数与局部晚期鼻咽癌患者预后相关性的前瞻性长期随访研究 |
| A prospective clinical study with long-term follow-up of the correlation between dynamic contrast-enhanced magnetic resonance parameters and prognosis in patients with locally advanced nasopharyngeal carcinoma |
| 投稿时间：2019-06-18 |
| DOI：10.3760/cma.j.issn.0254-5098.2020.06.006 |
| 中文关键词: 动态增强磁共振参数 鼻咽癌 疗效评价 预后指标 |
| 英文关键词:Dynamic contrast-enhanced magnetic resonance imaging Nasopharyngeal carcinoma Efficacy evaluation Prognostic factor |
| 基金项目:贵州省科技计划项目（LG[2012041]） |
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| 摘要点击次数: 1961 |
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| 中文摘要: |
| 目的 探讨动态增强磁共振（DCE-MRI）半定量参数与局部晚期鼻咽癌患者长期预后的关系，为局部晚期鼻咽癌患者预后寻找无创性的预测指标。方法 收集贵州省肿瘤医院2011年1月至2012年1月一项前瞻性临床研究的局部晚期鼻咽癌患者的临床信息，国际抗癌联盟（UICC）2010分期Ⅲ、ⅣA、ⅣB期，先行多西紫杉醇+顺铂+5'-氟尿嘧啶（TPF）方案时辰诱导化疗3周期；后予调强放疗（IMRT）同期紫杉醇化疗2周期。诱导化疗前均行DCE-MRI检查，并获取DCE-MRI相关半定量参数，将DCE-MRI相关半定量参数与同期放化疗结束的鼻咽病灶近期疗效进行相关性分析。结果 77例患者中，71例完成治疗并有长期完整随访信息，中位随访77个月（9~86个月），3年、5年OS分别为80.2%、67.6%；3年、5年PFS分别为73.2%、60.5%；同步放化疗结束鼻咽病灶近期疗效评价完全缓解（CR）组与部分缓解（PR）组之间的造影剂到达组织时间的差异具有统计学意义（t=0.537，P<0.05）；单因素生存分析发现，造影剂到达组织时间短组的OS（χ2=3.982，P<0.05）和PFS（χ2=4.019，P<0.05）均高于造影剂到达组织时间长组；年龄≥ 45岁的患者OS（χ2=7.593，P<0.05）和PFS（χ2=5.624，P<0.05）明显低于年龄<45岁的患者。Cox多因素回归模型发现，临床分期晚（ⅣA、ⅣB期）（P=0.048）、年龄≥ 45岁（P=0.031）是鼻咽癌患者OS的独立不良预后因素；而造影剂到达组织时间长（P=0.018）、年龄≥ 45岁（P=0.004）、N（2~3期）分期晚（P=0.032）和强化峰值<3 000（P=0.005）则为鼻咽癌患者PFS的独立不良预后因素。结论 DCE-MRI参数造影剂到达组织时间可能作为局部晚期鼻咽癌患者预后可靠的影像学指标。 |
| 英文摘要: |
| Objective To explore the relationship between semi-quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and long-term prognosis of locally advanced nasopharyngeal carcinoma, and to find prognostic indicators from non-invasive images of locally advanced nasopharyngeal carcinoma. Methods Data were collected from January 2011 to January 2012 via a prospective clinical trial with locally advanced nasopharyngeal carcinoma. Clinical information was from 71 patients who completed the treatment plan with long-term follow-ups and UICC 2010 stage Ⅲ, Ⅳ\-A,Ⅳ\-B. The patients received three cycles of Taxotere-Platinol-Fluorouracil (TPF) regimen chrono-chemotherapy, followed by two cycles of concurrent paclitaxel chemotherapy with intensity-modulated radiotherapy (IMRT). DCE-MRI examination was performed before induction chemotherapy to obtain DCE-MRI related semi-quantitative parameters. Correlation analysis was conducted between DCE-MRI related semi-quantitative parameters and short-term efficacy of nasopharyngeal lesions after concurrent radiotherapy and chemotherapy. Results Of all 77 patients, 71 completed treatment and were followed up from 9 to 86 months, with a median follow-up of 77 months, with 80.2% and 67.6% in 3- and 5-year OS, 73.2% and 60.5% in 3- and 5-year PFS, respectively. Evaluation of short-term efficacy of nasopharyngeal lesions after concurrent chemoradiotherapy:the difference in tissue arrival time of contrast agent between complete response (CR) group and partial response (PR) group was statistically significant (t=0.537, P<0.05). Univariate survival analysis found that OS (χ2=3.982,P<0.05) and PFS (χ2=4.019,P<0.05) in the group with short contrast arrival time were significantly higher than those in the group with long contrast arrival time. OS (χ2=7.593,P<0.05) and PFS (χ2=5.624,P<0.05) of patients aged over 45 years were significantly lower than those aged less than 45 years. Cox multivariate regression model showed that advanced clinical stage (stage Ⅳ\-A, Ⅳ\-B) (P=0.048) and age ≥ 45 years (P=0.031) were independent prognostic factors of OS in patients with nasopharyngeal carcinoma. Long arrival time of contrast agent (P=0.018), age ≥ 45 years (P=0.004), advanced N(2-3) stage (P=0.032) and enhancement peak<3 000 (P=0.005) were independent prognostic factors of PFS in patients with nasopharyngeal carcinoma. Conclusions The arrival time of the contrast agent in DCE-MRI may be a reliable prognostic factor for locally advanced nasopharyngeal carcinoma. |
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