规律治疗后监测与鼻咽癌生存改善相关：一项回顾性研究
Regular post-treatment surveillance is associated with improved survival in nasopharyngeal carcinoma: a retrospective study.
文献信息
| PMID | 42858857 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Chen-Fei Wu |
| 作者单位 | Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, PR China; Department of Radiation Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, PR 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
目的： 鼻咽癌（NPC）具有高复发风险，但其治疗后监测的获益尚未被探索。我们探讨了规律治疗后监测是否有助于更早发现复发并改善生存。
方法： 我们在中山大学肿瘤防治中心识别了8,798例非转移性I-IVA期NPC患者。选择1年里程碑分析作为监测模式的代表，根据监测强度将患者分为规律监测组和不规律监测组。Cox比例风险模型阐明了总生存（OS）与监测强度之间的关联，并按临床分期和治疗前Epstein-Barr病毒DNA水平进行亚组分析。还研究了针对局部、区域和远处部位的监测影像对生存的影响。
结果： 中位随访时间为64.8个月。1年里程碑分析包括4,078例接受规律监测（第一年≥4次就诊）和4,720例接受不规律监测（<4次就诊）的患者。多变量调整后，规律监测与更短的中位复发时间（26.1个月 vs 27.0个月）和改善的OS相关（HR，0.86；95% CI，0.74-0.99；P=0.032）。值得注意的是，接受规律远处部位影像监测的患者OS更好（HR，0.69；95% CI，0.57-0.82；P<0.001），而局部（HR，1.36；95% CI，0.90-2.04；P=0.140）和区域（HR，0.85；95% CI，0.57-1.27；P=0.428）部位影像监测则没有。规律监测的远处转移患者表现出更少的转移器官（P<0.001）和更早的复发分期（P<0.001），从而转化为延长的复发后生存（HR，0.68；95% CI，0.58-0.80；P<0.001）。
结论： 规律治疗后监测，特别是远处影像监测，可以改善NPC生存，凸显了基于证据的治疗后监测策略的紧迫性。
英文摘要
PURPOSE: Benefit of post-treatment surveillance in nasopharyngeal carcinoma (NPC), characterized by high recurrence risk, remains unexplored. We explored whether regular post-treatment surveillance facilitates earlier recurrence detection and improves survival.
METHODS AND MATERIALS: We identified 8,798 patients with non-metastatic stage I-IVA NPC at Sun Yat-sen University Cancer Center. The 1-year landmark analysis was chosen as representative of surveillance patterns, dividing patients into regular and irregular surveillance group based on surveillance intensity. Cox proportional hazards models clarified the association between overall survival (OS) and surveillance intensity, with subgroup analyses stratified by clinical stage and pretreatment Epstein-Barr virus DNA level. Survival impact of surveillance imaging for local, regional, and distant sites were also investigated.
RESULTS: Median follow-up was 64.8 months. 1-year landmark analysis comprised 4,078 and 4,720 patients receiving regular (≥ 4 visits in the first year) and irregular surveillance (< 4 visits), respectively. Regular surveillance was linked to shorter median recurrence time (26.1 versus 27.0 months) and improved OS (HR, 0.86; 95% CI, 0.74-0.99; P = 0.032) after multivariable adjustment. Notably, patients receiving regular imaging surveillance for distant site had better OS (HR, 0.69; 95% CI, 0.57-0.82; P < 0.001) whereas imaging for local (HR, 1.36; 95% CI, 0.90-2.04; P = 0.140) and regional site (HR, 0.85; 95% CI, 0.57-1.27; P = 0.428) did not. Regular surveillance patients with distant metastases exhibited fewer metastatic organs (P < 0.001) and earlier recurrence stages (P < 0.001), translating into prolonged post-recurrence survival (HR, 0.68; 95% CI, 0.58-0.80; P < 0.001).
CONCLUSIONS: Regular post-treatment surveillance, particularly distant imaging, could improve NPC survival, highlighting an urgency for evidence-based post-treatment surveillance strategies.