Multivariate Analysis Of Prognosis In Stage Ⅲ-IVB Nonkeratinizing Nasopharyngeal Carcinoma

Background:Nasopharyngeal carcinoma(NPC)is a malignant tumor that occurs in the nasopharynx and its side wall,and its incidence is the first in head and neck tumors in my country.There are three pathological subtypes of nasopharyngeal carcinoma:keratinizing squamous cell carcinoma,non-keratinizing squamous cell carcinoma and basaloid squamous cell carcinoma.Non-keratinizing squamous cell carcinoma is divided into differentiated carcinoma and undifferentiated carcinoma.Nasopharyngeal carcinoma has the characteristics of insidious location and prone to metastasis and recurrence.Most patients are already locally advanced when they are diagnosed.Therefore,the 5-year survival rate is relatively low and the prognosis is poor.Epidemiological studies have found that the incidence of nasopharyngeal carcinoma has a certain correlation with region and ethnicity,and the factors affecting its prognosis are relatively complex,and there are few related reports on the influencing factors of stage Ⅲ-ⅣB non-keratinizing nasopharyngeal carcinoma.Therefore,studying the prognostic factors that affect stage Ⅲ-ⅣB non-keratinizing nasopharyngeal carcinoma has important academic value.Purpose:This study aims to analyze the relevant prognostic factors of patients with stageⅢ-ⅣB non-keratinizing nasopharyngeal carcinoma,establish an effective curative effect prediction and prognostic model,so as to reduce the local recurrence and distant metastasis of nasopharyngeal carcinoma and improve the patient’s The quality of life,the purpose of improving the survival time of patients,and at the same time providing new evidence-based medical evidence for clinical practice.Methods:Using retrospective analysis methods,a total of 67 patients with stage Ⅲ-ⅣB non-keratinizing nasopharyngeal carcinoma who were admitted to XXX Hospital from January 2010 to March 2021 were collected.The case data was screened and finally 53 patients were enrolled.The basic information and clinical data of 53 patients with stage Ⅲ-ⅣB non-keratinizing nasopharyngeal carcinoma were counted,and the patients included in the study were followed up,and a detailed research database was established.SPSS 25.0 software was used for statistical analysis.The Kaplan-Meire method was used to calculate the survival rate and draw the survival curve,the Log Rank test was used for univariate analysis,and the Cox risk regression model was used for multivariate analysis to analyze the prognostic factors.The processing of missing values is filled with the mean value of the sequence.Results:A total of 53 patients with stage Ⅲ-ⅣB non-keratinizing nasopharyngeal carcinoma were included in this study.The 1-year,3-year,5-year progression-free survival of all patients were 83.30%,59.90%,and 47.60%,respectively;the overall survival was 93.90%,64.40%,and 50.20%,respectively.Univariate analysis results showed:drinking history(P=0.014),distant metastasis(M staging,P=0.044),neutrophils(P<0.001),platelets(P=0.012),neutrophils/lymphocytes The ratio(P=0.041),whether radiotherapy(P<0.001),and whether concurrent radiotherapy and chemotherapy combined with targeted therapy(P=0.036)are correlated with PFS in patients with nasopharyngeal carcinoma.Clinical stage(P=0.040),distant metastasis(M stage,P=0.011),white blood cells(P=0.008),neutrophils(P=0.001),neutrophil/lymphocyte ratio(P=0.040),Radiotherapy(P<0.001),TCM treatment time(P=0.014)are correlated with OS in patients with nasopharyngeal carcinoma.Non-keratinizing differentiated type and non-keratinizing undifferentiated type are not statistically significant with PFS and OS of this group of patients(PFS:P=0.291;OS:P=0.193).The treatment of immune checkpoint inhibitors has no effect on the recurrence and recurrence of this group.Patients with unresectable or metastatic non-keratinizing nasopharyngeal carcinoma did not have a survival benefit(P=0.644),which is considered to be related to the small sample size in this group.The results of multivariate Cox regression analysis showed that clinical staging(P=0.005),platelets(P=0.011),and whether concurrent radiotherapy and chemotherapy combined with targeted therapy(P=0.004)affect patients with stage Ⅲ-ⅣB non-keratinizing nasophatyngeal carcinoma Independent prognostic factors of PFS;clinical stage(P=0.002).white blood cells(P=0.015),neutrophil/lymphocyte ratio(P=0.030).whether concurrent radiotherapy and chemotherapy are combined with targeted therapy(P=0.004),medium Medical treatment time(P=0.002)is an independent prognostic factor affecting OS in patients with stage Ⅲ-ⅣB non-keratinizing nasopharyngeal carcinoma.Conclusion:Clinical stage,platelet level,and inflammatory state are all independent prognostic factors for patients with stage Ⅲ-ⅣB non-keratinizing nasopharyngeal carcinoma.In other words,the later the clinical stage,the higher the platelet level and inflammatory state.and the worse the prognosis of patients with nasopharyngeal cancer.Alcohol consumption is also a risk factor affecting the prognosis of patients with stage Ⅲ-ⅣB non-keratinizing nasopharyngeal carcinoma.Comprehensive treatment based on radiotherapy and chemotherapy is the main treatment mode for patients with stage Ⅲ-ⅣB non-keratinizing nasopharyngeal carcinoma in this study.Simultaneous radiotherapy and chemotherapy combined with targeted therapy are independent prognostic factors for patients with nasopharyngeal carcinoma,which can significantly improve patients For PFS,it is considered that simultaneous radiotherapy and chemotherapy combined with targeted therapy represented by nimotuzumab will have survival benefits for patients with nasopharyngeal carcinoma.Immunotherapy did not yield a survival benefit in this group of patients with recurrent unresectable or metastatic non-keratinized nasopharyngeal carcinoma.High exposure(4M)of traditional Chinese medicine treatment is an independent protective factor for OS in patients with nasopharyngeal carcinoma.Prolonged treatment with traditional Chinese medicine can reduce the risk of death and improve the long-term survival rate of patients.At the same time,it is also stage Ⅲ-ⅣB non-keratosis patients with sexual nasopharyngeal carcinoma provide effective treatment strategies.