Outcomes And Prognostic Factors Of481Patients For Nasopharyngeal Carcinoma

1. Prognosis and study of the staging system of481cases with nasopharyngeal carcinomaObjective This study aims to analyze the outcome and prognostic fact-ors of481cases of nasopharyngeal carcinoma and compare the’92FuZ-hou staging system and6th AJCC staging system.Methods For this retrospective analysis, the treatment records of481patients newly diagnosed as NPC for the first time from Janurary2005to December2008in our hospital were reviewed. Patients were re-graded in accordance with the’92staging and6th AJCC staging system. We compa-red the risk consistency and difference of the two staging system and analyzed the prognostic factors.Results1) The4-year local-regional control(LRC),distant metastasis-free survival(DMFS), disease-free survival (DFS), overall survival (OS) of IMRT group and CRT group were90.4%,75.0%68.2%and76.0%, respectively. Compared to92Fuzhou staging, in6th AJCC staging system, the proportion of Ⅱ grade increased, the proportion of Ⅲ and Ⅳ grade decreased. As for T stage, the overall survival curves of ’92Fuzhou staging separate relatively better. In ’92Fuzhou staging, no significant difference was found between T2and T3group, T3and T4groups respectively(P=0.128and0.473). In6th AJCC staging, T1and T2, T2and T3, T3and T4were not significantly different between respectively (P=0.053,0.071and0.918). In ’92Fuzhou staging, No statistically significant differences were found between, NO and N1, N2and N3group (P=0.931and0.721, respectively). In6th AJCC staging, NO and N1, N2and N3group were not statistically difference (P=0.645and0.578, respectively). In ’92Fuzhou staging, curves between Ⅲ and Ⅳ grade was of no significant difference (P=0.196). In6th the AJCC stage, curves between Ⅲ and Ⅳ grade was of no significant difference (P=0.281).2) Univariate analysis revealed that that age, the carotid sheath invasion, the skull base invasion, stage, T stage, N stage, lymph node sides were significant prognostic factors with overall survival; skull base invasion,cranial nerve invasion, stage, T stage, N stage, lymph nodes lateral/bilateral were significant prognostic factors with the tumor-free survival; T stage, IMRT/CRT, chemotherapy, with or without sensitizers were relevant factors of local recurrence-free survival;age, skull base invasion, cranial nerve invasion, stage, T stage, N stage, lymph node sides were significant prognostic factors with DMFS (P<0.05).3) Multivariate analysis showed that T stage, lymph nodes of unilateral and bilateral were independent prognostic factors of overall survival (P values of’92Fuzhou stagingwere0.030,0.039, P values of6th AJCC staging were0.030,0.039); T stage, N stage were independent prognostic factors of disease-free survival (P values of’92Fuzhou staging were0.001,0.019, P values of6th AJCC staging were0.000,0.007), while the prognostic factors for overall survival rates were different (P value of’92Fuzhou staging was0.306, P value of6th AJCC staging was0.031); T stage was an independent prognostic factor of no distant metastasis survival (P value of’92Fuzhou staging was0.022, P value of6th AJCC staging was0.034).Conclusion T stage, N stage were independent prognostic factors for overall survival, disease-free survival and distant metastasis free survival’s stage and radio-therapeutic methods were independent prognostic factors for local-regional control.2. Outcomes and prognostic factors of conformal radiotherapy versus intensity-modulated radiotherapy for nasopharyngeal carcinomaObjective This study aims to compare outcomes and prognostic factors of nasopharyngeal carcinoma (NPC) treated with conformal radio-therapy (CRT) and with intensity-modulated radiotherapy (IMRT).Methods For this retrospective analysis, the treatment records of380patients newly diagnosed as NPC for the first time from January2005to December2008in our hospital were reviewed.182cases treated with IMRT,198cases treated with CRT. The clinical characteristics, trea-tment outcomes (including survival analysis and acute, late toxicity) and prognostic factors of two groups were compared.Results1) The4-year local-regional control(LRC), distant metas-tasis-free survival(DMFS), disease-free survival (DFS), overall survival (OS) of IMRT group and CRT group were93.6%and85.3%,79.1%and73.6%,74.7%and65.0%,83.5%and72.1%,respectively.2) The acute radiation dermatitis and xerostomia of the two groups were significantly different (P<0.05).3) Survival analysis showed that, in IMRT group, OS between different T stages can not be well separated. Multivariate anal-ysis revealed that, in CRT group, the clinical stage or T and N stage were significant prognostic factors for OS、DMFS and DFS, T stage was a significant prognostic factor LRC. In IMRT group, T stage and N stage had no predictive value for outcomes.Conclusion Compared with CRT, patients treated with IMRT has a better prognosis and less adverse effect. For patients treated with IMRT, T stage was not a significant prognostic factor for LRC, DMFS, DFS or OS. Effective treatment strategy is needed for distant control. With the increasing utilization of IMRT in the treatment of NPC and the continu-ing modulated treatment strategies, current staging system face great cha-llenges.