| Objective To extract data on nasopharyngeal carcinoma registered in China Cancer Registration Annual Report,analyzing the incidence and mortality of nasopharyngeal carcinoma in China,and providing scientific basis for formulating prevention and control strategies for nasopharyngeal cancer in China.Systematic evaluation of the effect of intensity-modulated radiotherapy and two-dimensional conventional radiotherapy on long-term survival rate of patients with nasopharyngeal carcinoma,providing a reference for clinical treatment strategies.Based on the previous research results,the research plan was developed to investigate the clinical case data of high incidence areas of nasopharyngeal carcinoma,and to explore the influencing factors of acute injury effects after radiotherapy in patients with nasopharyngeal carcinoma.Methods(1)Collecting and sorting out the incidence and mortality of nasopharyngeal carcinoma in China from 2005 to 2013,using the Joinpoint regression model to analyze the time-varying trends of standardized morbidity and mortality of nasopharyngeal carcinoma,and age-specific trends;(2)Searching Chinese and English databases for selecting the related Randomized controlled trials or observational studies comparing the effects of conventional radiotherapy on long-term outcomes in patients with nasopharyngeal carcinoma.The search timeline was as of December 30,2018.Two reviewers independently screened the literature,extracted data,and evaluated the literature quality according to inclusion and exclusion criteria.Stata12.0 software was used by meta-analysis;(3)To collect clinical data of 996 patients with nasopharyngeal carcinoma radiotherapy from Hunan Cancer Hospital and Nanhua Hospital affiliated to Nanhua University,and collect clinical information on age,sex,height,weight,smoking,drinking,clinical stage and T stage of the case,and extract the main patients.Radiotherapy damage effects,including acute mucosal reactions,dry mouth,skin damage,gastrointestinal reactions,bone marrow suppression.Results(1)For the incidence: the overall trend is declining,the incidence of nasopharyngeal cancer has a significant turning point from 2009 to 2010,and the city showed an upward trend before 2009(APC=3.0%,P=0.3),after 2009 a downward trend(APC=-5.8%,P<0.05).The incidence of nasopharyngeal carcinoma in rural areas showed a rapid decline before 2009(APC=-17.64%,P=0.2),and showed a slow upward trend after 2009.(APC=4.24%,P=0.6),the gap between urban and rural areas is gradually narrowing.The incidence of standardization of nasopharyngeal cancer in Chinese males has been higher than that of females,which is 2.30~2.45 times of female population.The incidence of male and female is decreasing with time.(APC<0,P<0.05).The age-specific incidence of nasopharyngeal carcinoma in 0~25 years old population is milder and lower,and the incidence of 25~60 years old people gradually increases with age,and the peak incidence occurred in the 50~60 age group every year.For mortality rate,nasopharyngeal cancer mortality showed a significant turning point from 2009 to 2010,and the city showed an upward trend before 2009(APC=3.09%,P=0.2),a downward trend after 2009(APC=-7.27%),P<0.05).The mortality rate of nasopharyngeal carcinoma in rural areas showed a rapid decline before 2009(APC=-22.81%,P=0.1),and showed a slow upward trend after 2009(APC=3.60%,P=0.6).The gap between urban and rural areas is gradually narrowing.The standardized mortality rate of nasopharyngeal carcinoma in Chinese men has been higher than that of females,which is 2.54~3.09 times of female population.The overall mortality rate of male and female patients decreases with time(APC<0,P<0.05);The trend of age-specific mortality of nasopharyngeal carcinoma in the 0~25 year old population is relatively flat and low.After the age of 25,various years have an increasing trend with age.(2)18 articles(5 RCTs,13 retrospective cohort studies)were finally included in the literature,with a total of 18273 patients with nasopharyngeal carcinoma.The results showed that,compared with conventional therapy,a 3-year overall survival rate[OR=2.99,95% CI(2.12,4.21),P<0.001] for patients with nasopharyngeal carcinoma who received IMRT,5-year overall survival [OR=1.54,95% CI(1.38,1.72),P <0.001],5-year local recurrence-free survival rate [OR=1.85,95% CI(1.38,2.47),P <0.001],5-year distant metastasis survival rate [ OR=1.16,95% CI(1.03,1.30),P=0.011],all increased significantly;and the 5-year progression-free survival rate was close to statistical significance(P=0.052),and the accuracy of the results needs further study verification.(3)There were no significant differences in acute mucosal reaction,dry mouth,skin damage,gastrointestinal reactions,and myelosuppression in patients with nasopharyngeal carcinoma of different ages,smoking,alcohol consumption,and T stage.The incidence of dry mouth was higher in men than in women.Gastrointestinal reactions in patients with stage III/IV were higher than those in stage I/II after radiotherapy,and the difference was statistically significant.Secondly,there was no statistical difference between acute mucosal reaction,dry mouth,skin damage and gastrointestinal reactions in the lean group,the normal group and the overweight and obesity group.The bone marrow suppression showed statistical difference,and then the bone marrow suppression index was performed in pairs.In comparison,the difference between the normal group and the overweight and obesity group was statistically significant.Conclusions(1)The incidence and mortality of nasopharyngeal carcinoma in China showed a downward trend in 2005~2013.There were obvious age and gender differences in morbidity or mortality.The urban-rural gap gradually narrowed.After 25 years old,the incidence and mortality showed a trend of growth and maintained a high level.The prevention and treatment of nasopharyngeal cancer should be focused in men over 25 years of age.(2)NPC patients receiving IMRT can effectively improve 3-year overall survival,5-year overall survival,local recurrence-free survival,and no distant metastasis survival rate,but no significant improvement in 5-year progression-free survival.(3)For patients with nasopharyngeal carcinoma,attention should be paid to the occurrence of dry mouth in men,the gastrointestinal reactions in patients with advanced disease,and the occurrence of myelosuppression in patients with normal body mass index. |
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