鼻咽癌放疗后放射性相关第二原发恶性肿瘤的风险及预后生存分析：调强放疗与二维放疗
Risk and prognostic survival analysis of radiation-related second malignant neoplasms following radiotherapy for nasopharyngeal carcinoma: intensity-modulated radiotherapy and two-dimensional radiotherapy.
文献信息
| PMID | 42732821 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Renyuan Huang |
| 作者单位 | State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China. |
| 期刊 | Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology |
| SCI 分区 | Q1 |
| IF | 5.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
背景与目的： 阐明在调强放疗（IMRT）队列与历史二维放疗（2D-RT）队列中，鼻咽癌幸存者第二原发恶性肿瘤（SMN）的长期风险及预后意义。
材料与方法： 我们分别提取了8,032例和39,118例初诊、非转移性鼻咽癌患者的数据，这些患者分别接受了IMRT±化疗和2D-RT±化疗。采用单因素和多因素Cox比例风险模型评估IMRT队列中SMN发生的危险因素。采用Kaplan-Meier法评估生存结局。
结果： IMRT队列中有212例患者发生放射性相关SMN，历史2D-RT队列中有247例患者发生放射性相关SMN，对应的观察粗比例分别为3.49%和0.63%。在IMRT队列中，5年、10年和15年竞争风险累积发生率分别为1.15%、3.09%和6.66%。IMRT队列中SMN诊断的中位潜伏期为7.3年，历史2D-RT队列为9.5年。口腔和鼻腔鼻窦区域是常见的SMN部位，鳞状细胞癌是主要组织学类型。在IMRT队列的多因素Cox分析中，男性、年龄≤50岁和吸烟史与SMN发生独立相关。在发生SMN的患者中，IMRT队列的5年总生存率为38.6%，历史2D-RT队列为29.3%。
结论： 在这项跨时代的机构研究中，与历史2D-RT队列相比，IMRT队列显示出数值上更高的观察粗发生率和更短的放射性相关SMN潜伏期。男性、较年轻年龄和吸烟史是SMN发生的独立危险因素。在发生SMN的患者中，IMRT队列的观察总生存估计值更高。
英文摘要
BACKGROUND AND PURPOSE: To clarify the long-term risk and prognostic implications of second malignant neoplasms (SMNs) among nasopharyngeal carcinoma survivors in intensity-modulated radiotherapy (IMRT) and historical two-dimensional radiotherapy (2D-RT) cohorts.
MATERIALS AND METHODS: We extracted data from 8,032 and 39,118 initially diagnosed, non-metastatic NPC patients treated with IMRT ± chemotherapy and 2D-RT ± chemotherapy, respectively. Risk factors for SMN development in the IMRT cohort were evaluated using univariate and multivariable Cox proportional hazards models. Survival outcomes were assessed using the Kaplan-Meier method.
RESULTS: Radiation-related SMNs occurred in 212 patients in the IMRT cohort and 247 patients in the historical 2D-RT cohort, corresponding to observed crude proportions of 3.49% and 0.63%, respectively. In the IMRT cohort, the 5-, 10-, and 15-year competing-risk cumulative incidences were 1.15%, 3.09%, and 6.66%, respectively. Median latency to SMN diagnosis was 7.3 years in the IMRT cohort and 9.5 years in the historical 2D-RT cohort. The oral cavity and sinonasal region were common SMN sites, and squamous cell carcinoma was the predominant histology. In multivariable Cox analysis within the IMRT cohort, male sex, age ≤ 50 years, and smoking history were independently associated with SMN development. Among patients with SMNs, 5-year overall survival was 38.6% in the IMRT cohort and 29.3% in the historical 2D-RT cohort.
CONCLUSIONS: In this cross-era institutional study, the IMRT cohort showed a numerically higher observed crude incidence and shorter latency of radiation-related SMNs than the historical 2D-RT cohort. Male sex, younger age, and smoking history were independent risk factors for SMN development. Among patients who developed SMNs, observed overall survival estimates were higher in the IMRT cohort.