摘要
目的 探讨治疗前血清乳酸脱氢酶(lactate dehydrogenase,LDH)水平在挽救性调强放疗(IMRT)的局部复发性鼻咽癌(NPC)患者中的预后价值,并确定与rT分级的相关性.方法 回顾性分析2018年1月～2022年4月在深圳市龙岗区耳鼻咽喉医院接受挽救性IMRT治疗的97例局部复发、非转移性NPC患者的病例资料,其中死亡51例、远处转移18例、局部失败30例和出现预后不良事件(死亡、肿瘤远处/局部转移)67例.获得所有患者临床资料、局部无失败生存(local failure-free survival,LFFS)、无远处转移生存(distant metastasis-free survival,DMFS)和总生存时间(overall survival,OS),分析LDH与NPC患者挽救性IMRT预后的关系.结果 死亡组[221.25(178.24,339.13)U/L vs.124.82(79.0,159.50)U/L,Z=-5.122]、局部失败组[230.75(170.89,394.50)U/L vs.157.85(91.78,216.95)U/L,Z=-3.442]、远处转移组[261.62(153.55,465.50)U/L vs.168.98(101.75,237.75)U/L,Z=-2.478]和预后不良组[220.05(167.20,506.16)U/L vs.93.45(69.95,154.35)U/L,Z=-6.018]患者挽救性IMRT前血清LDH水平显著更高,P均<0.05.将血清LDH水平根据中位值划分为二分类变量(≥177.50 U/L vs.<177.50 U/L),Cox单因素模型发现LDH影响LFFS、DMFS、OS和毒性相关死亡(toxic-related death,TRD)的危险比分别为3.759(1.660～8.558)、4.217(1.383～12.861)、3.226(1.715～6.069)、3.363(1.750～6.463),P<0.05.多变量回归分析中,LDH仍然是LFFS、DMFS、OS、TRD的独立预后因素(P<0.05).与LDH<177.50 U/L患者比较,LDH≥177.50 U/L组患者更多发生肿瘤局部进展相关死亡,且LDH≥177.50 U/L组患者无LFFS期、无DMFS期和OS期更短(Log-rank=11.624、7.559、14.758),P均<0.05.在预测总生存率方面,在rT分级中加入LDH优于单独的rT分级.结论 LDH是预测局部复发、非转移性NPC患者在挽救IMRT后LFFS、DMFS、OS和TRD的一个重要因素,LDH与rT分级联合预测总生存率的价值较高.
Abstract
OBJECTIVE To investigate the prognostic value of pre-treatment serum lactate dehydrogenase(LDH)levels in patients with locally recurrent nasopharyngeal carcinoma(NPC)treated with salvage intensity-modulated radiotherapy(IMRT)and to determine its association with rT staging.METHODS The records of 97 patients with locally relapsed and non-metastatic NPC who received salvage IMRT treatment in our center from January 2018 to April 2022 were collected,including 51 patients who died,18 patients with distant metastases,30 patients with local failure,and 67 patients with prognostic adverse events(death,distant tumors/local metastases).Clinical data,local failure-free survival(LFFS),distant metastasis-free survival(DMFS)and overall survival(OS)were obtained from all patients,and the relationship between LDH and the prognosis of salvage IMRT therapy in NPC patients was analyzed.RESULTS The serum LDH level before salvage IMRT was significantly higher in the death[221.25(178.24,339.13)U/L vs.124.82(79.0,159.50)U/L,Z=-5.122],local failure[230.75(170.89,394.50)U/L vs.157.85(91.78,216.95)U/L,Z=-3.442],distant metastasis[261.62(153.55,465.50)U/L vs.168.98(101.75,237.75)U/L,Z=-2.478]and poor prognosis group[220.05(167.20,506.16)U/L vs.93.45(69.95,154.35)U/L,Z=-6.018],and all P<0.05.Serum LDH levels were divided into dichotomous variables according to median values(≥177.50 U/L vs.<177.50 U/L),the Cox univariate model found that the hazard ratios of LDH affecting LFFS,DMFS,OS and toxic-related death(TRD)were 3.759(1.660-8.558),4.217(1.383-12.861),3.226(1.715-6.069),3.363(1.750-6.463),P<0.05.LDH remained an independent prognostic factor for LFFS,DMFS,OS,and TRD in multivariate regression analysis(P<0.05).Compared with patients with LDH<177.50 U/L,more patients in the LDH≥177.50 U/L group had local progression-related death,and the no LFFS stage,no DMFS stage and OS were shorter in the LDH≥177.50 U/L group(log rank=11.624,7.559,14.758),P<0.05.In predicting overall survival,adding LDH to the rT stage is preferable to the rT stage alone.CONCLUSION LDH is an important factor in predicting LFFS,DMFS,OS,and TRD after saving IMRT in patients with locally relapsed,non-metastatic NPC,and the value of LDH combined with rT staging in predicting overall survival is high.
基金项目
深圳市龙岗区科技发展专项(GKCYLMSZ020097)
维普
万方数据