多西他赛联合奈达铂在局部晚期鼻咽癌中的近远期疗效、安全性及预后分析(1)
[摘要] 目的 探讨多西他赛联合奈达铂(TP)及氟尿嘧啶联合顺铂(PF)的诱导化疗方案在局部晚期鼻咽癌的有效性及安全性。 方法 回顾性分析2012年1月～2014年5月在浙江省肿瘤医院接受TP或PF诱导化疗方案的271例患者，8例失访，最终263例纳入分析，其中PF组92例，TP组171例，比较两组患者的疗效、安全性及预后。结果 两组5年总生存率(OS)、无进展生存率(PFS)、局部无复发生存率(LRFS)、无远处转移生存率(DMFS)比较，差异均无统计学意义(均P > 0.05)。进一步多因素分析显示，N分期是5年OS、PFS和DMFS的独立预后因素(P < 0.05)。不良反应分析显示，TP组更容易发生3～4级的白细胞、中性粒细胞和血小板减少，而PF组更容易发生3～4级的恶心和呕吐，差异有统计学意义(P < 0.05)。两组其余不良反应比较，差异无统计学意义(P > 0.05)。结论TP和PF的诱导化疗治疗局部晚期鼻咽癌效果相当，不良反应均可耐受，可用于治疗局部晚期鼻咽癌。
[关键词] 诱导化疗;奈达铂;多西他赛;鼻咽癌
[中图分类号] R739.6 [文献标识码] A [文章编号] 1673-7210(2019)08(b)-0150-06
[Abstract] Objective To evaluate the efficacy and safety of Docetaxel combined with Nedaplatin (TP) and Fluorouracil combined with Cisplatin (PF) in the treatment of locally advanced nasopharyngeal carcinoma. Methods Retrospective analysis of 271 patients who received TP or PF induction chemotherapy in Zhejiang Cancer Hospital from January 2012 to May 2014， 8 cases were lost to follow-up， and 263 cases were finally included in the analysis， including 92 cases in PF group and 171 cases in TP group. Efficacy， safety and prognosis of the two groups were compared. Results The 5-year overall survival rate (OS)， progression-free survival rate (PFS)， local recurrence free survival rate (LRFS)， and distant metastasis free survival rate (DMFS) were compared， the differences were not statisticdly significant between the two groups (all P > 0.05). Further multivariate analysis showed that N staging was an independent prognostic factor for 5-year OS， PFS and DMFS (P < 0.05). Adverse reaction analysis showed that grade 3-4 leukopenia， neutrophilia and thrombocytopenia were more likely to occur in the TP group， while grade 3-4 nausea and vomiting were more likely to occur in the PF group， with statistically significant differences (P < 0.05). There were no statistically significant differences in other adverse reactions between the two groups (P > 0.05). Conclusion The efficacy of TP and PF induction chemotherapy in the treatment of locally advanced nasopharyngeal carcinoma is similar， and the adverse reactions are tolerable， which can be used in the treatment of locally advanced nasopharyngeal carcinoma.
[Key words] Neoadjuvant chemotherapy; Nedaplatin; Docetaxel; Nasopharyngeal carcinoma
鼻咽癌是起源于鼻咽上皮的惡性肿瘤，好发于中国的南部和东南亚地区[1]。放疗是目前鼻咽癌主要的治疗手段。T1N0M0的早期鼻咽癌患者采用单纯放疗就可达到根治的效果，5年生存率为84%～90%[2]。但70%左右的患者就诊时已属于中晚期，易发生局部复发及远处转移，单纯放疗已不能达到根治的效果。目前，以铂类为基础的同步放化疗是鼻咽癌的一线治疗手段[3]。但同步放化疗对于鼻咽部病灶广泛或颈部大肿块、广泛淋巴结转移的患者疗效欠佳[4]。近年来，诱导化疗联合含铂的同步放化疗已经成为局部晚期鼻咽癌治疗的首选方案，但最佳的诱导化疗方案尚无定论。因此，本研究回顾性分析多西他赛联合奈达铂(docetaxel plus nedaplatin，TP)对比氟尿嘧啶联合顺铂(fluorouracil plus cisplatin，FP)诱导化疗方案序贯顺铂为基础的同期放化疗在局部晚期鼻咽癌中的疗效及不良反应。, 百拇医药(刘同欣 孙权权 陈晶)
[关键词] 诱导化疗;奈达铂;多西他赛;鼻咽癌
[中图分类号] R739.6 [文献标识码] A [文章编号] 1673-7210(2019)08(b)-0150-06
[Abstract] Objective To evaluate the efficacy and safety of Docetaxel combined with Nedaplatin (TP) and Fluorouracil combined with Cisplatin (PF) in the treatment of locally advanced nasopharyngeal carcinoma. Methods Retrospective analysis of 271 patients who received TP or PF induction chemotherapy in Zhejiang Cancer Hospital from January 2012 to May 2014， 8 cases were lost to follow-up， and 263 cases were finally included in the analysis， including 92 cases in PF group and 171 cases in TP group. Efficacy， safety and prognosis of the two groups were compared. Results The 5-year overall survival rate (OS)， progression-free survival rate (PFS)， local recurrence free survival rate (LRFS)， and distant metastasis free survival rate (DMFS) were compared， the differences were not statisticdly significant between the two groups (all P > 0.05). Further multivariate analysis showed that N staging was an independent prognostic factor for 5-year OS， PFS and DMFS (P < 0.05). Adverse reaction analysis showed that grade 3-4 leukopenia， neutrophilia and thrombocytopenia were more likely to occur in the TP group， while grade 3-4 nausea and vomiting were more likely to occur in the PF group， with statistically significant differences (P < 0.05). There were no statistically significant differences in other adverse reactions between the two groups (P > 0.05). Conclusion The efficacy of TP and PF induction chemotherapy in the treatment of locally advanced nasopharyngeal carcinoma is similar， and the adverse reactions are tolerable， which can be used in the treatment of locally advanced nasopharyngeal carcinoma.
[Key words] Neoadjuvant chemotherapy; Nedaplatin; Docetaxel; Nasopharyngeal carcinoma
鼻咽癌是起源于鼻咽上皮的惡性肿瘤，好发于中国的南部和东南亚地区[1]。放疗是目前鼻咽癌主要的治疗手段。T1N0M0的早期鼻咽癌患者采用单纯放疗就可达到根治的效果，5年生存率为84%～90%[2]。但70%左右的患者就诊时已属于中晚期，易发生局部复发及远处转移，单纯放疗已不能达到根治的效果。目前，以铂类为基础的同步放化疗是鼻咽癌的一线治疗手段[3]。但同步放化疗对于鼻咽部病灶广泛或颈部大肿块、广泛淋巴结转移的患者疗效欠佳[4]。近年来，诱导化疗联合含铂的同步放化疗已经成为局部晚期鼻咽癌治疗的首选方案，但最佳的诱导化疗方案尚无定论。因此，本研究回顾性分析多西他赛联合奈达铂(docetaxel plus nedaplatin，TP)对比氟尿嘧啶联合顺铂(fluorouracil plus cisplatin，FP)诱导化疗方案序贯顺铂为基础的同期放化疗在局部晚期鼻咽癌中的疗效及不良反应。, 百拇医药(刘同欣 孙权权 陈晶)