诊断至治疗间隔与放疗间隔对鼻咽癌生存的个体及累积影响
Individual and Cumulative Impacts of Diagnosis-to-Treatment Interval and Radiotherapy Interval on Survival in Nasopharyngeal Cancer.
文献信息
| PMID | 42808573 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Erkan Topkan |
| 作者单位 | Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey. |
| 期刊 | Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
目的： 评估诊断至治疗间隔（DTI）和放疗间隔（RTI）对接受同步放化疗（CCRT）的局部晚期鼻咽癌（LA-NPC）患者总生存期（OS）的影响。
研究设计： 回顾性数据库研究。
地点： 单一三级学术中心。
方法： 我们分析了2010年至2024年间接受CCRT治疗的285例LA-NPC患者。采用受试者工作特征（ROC）分析得出DTI和RTI的最佳阈值。采用Kaplan-Meier法估计OS，并用log-rank检验进行比较。多变量Cox模型评估独立相关性，风险比（HR）以95%置信区间（CI）报告。
结果： 中位随访75.6个月后，中位OS为108个月。应用ROC得出的DTI阈值30天和RTI阈值49天。DTI≤30天与>30天相比，OS改善（未达到 vs 64.0个月；P<.001），RTI≤49天与>49天相比亦然（122.0 vs 74.0个月；P<.001）。在多变量分析中，DTI>30天（HR：2.56，95% CI：[2.11-3.82]，P<.001）和RTI>49天（HR：1.65，95% CI：1.09-2.47，P=.002）与较差的OS独立相关。同时存在两种延迟的患者生存最差（中位OS：51.0个月）。DTI>30天与远处转移增加相关，而RTI>49天与更高的局部区域失败相关。
结论： DTI>30天和RTI>49天与接受根治性CCRT治疗的LA-NPC患者较差的生存独立相关。这些发现支持及时开始治疗和不间断地实施放疗。
英文摘要
OBJECTIVE: To evaluate the impact of diagnosis-to-treatment interval (DTI) and radiotherapy interval (RTI) on overall survival (OS) in locally advanced nasopharyngeal carcinoma (LA-NPC) treated with concurrent chemoradiotherapy (CCRT).
STUDY DESIGN: Retrospective database study.
SETTINGS: Single tertiary academic center.
METHODS: We analyzed 285 LA-NPC patients treated with CCRT between 2010 and 2024. Receiver operating characteristic (ROC) analysis was used to derive optimal thresholds for DTI and RTI. OS was estimated using the Kaplan-Meier method and compared with log-rank tests. Multivariable Cox models assessed independent associations, with hazard ratios (HRs) reported with 95% confidence intervals (CIs).
RESULTS: After a median follow-up of 75.6 months, median OS was 108 months. ROC-derived thresholds of 30 days for DTI and 49 days for RTI were applied. DTI ≤ 30 days was associated with improved OS compared with >30 days (not reached vs 64.0 months; P < .001), as was RTI ≤ 49 versus >49 days (122.0 vs 74.0 months; P < .001). On multivariable analysis, DTI > 30 days (HR: 2.56, 95% CI: [2.11-3.82], P < .001) and RTI > 49 days (HR: 1.65, 95% CI: 1.09-2.47, P = .002) were independently associated with inferior OS. Patients with both delays had the poorest survival (median OS: 51.0 months). DTI > 30 days was associated with increased distant metastasis, whereas RTI > 49 days was associated with higher locoregional failure.
CONCLUSION: DTI > 30 days and RTI > 49 days are independently associated with worse survival in LA-NPC treated with definitive CCRT. These findings support timely treatment initiation and uninterrupted radiotherapy delivery.