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目的:探讨诱导化疗与同期化疗对局部晚期鼻咽癌患者的远期疗效及安全性。方法:以2006-01-2011-01期间收治的190例符合研究标准的鼻咽癌患者为研究对象,其中接受诱导化疗加放疗者92例,为诱导组;接受同期放化疗加辅助化疗者98例,为同期组。对比分析2组患者的一般资料、总生存率、无进展生存率、急慢性不良反应等,并分析局部晚期鼻咽癌的预后不良因素。结果:诱导组和同期组5年无进展生存率(70.7%、67.3%,P=0.591)和总生存率(78.3%、78.6%,P=0.635)均差异无统计学意义。2组复发或转移率差异无统计学意义(29.3%、35.7%,P=0.435)。与同期组相比,诱导组Ⅲ~Ⅳ级白细胞减少及恶心呕吐的发生率明显更低,差异有统计学意义(均P<0.05);2组间晚期不良反应的发生率差异无统计学意义(P>0.05)。多因素分析结果显示年龄(P=0.000)和N分期(P=0.003)是局部晚期鼻咽癌患者总生存率的独立预后影响因素。结论:诱导化疗加放疗与同期放化疗加辅助化疗对局部晚期鼻咽癌患者的疗效相当,且诱导化疗加放疗相关的急性不良反应发生率低。因此,诱导化疗加放疗可能是更为有效、安全的治疗方式。
Objective: To investigate the long-term efficacy and safety of induction chemotherapy and concurrent chemotherapy in patients with locally advanced nasopharyngeal carcinoma. Methods: A total of 190 patients with nasopharyngeal carcinoma meeting the research criteria were enrolled in the study. Among them, 92 patients undergoing induction chemotherapy plus radiotherapy were the induction group and those receiving concurrent chemoradiation plus adjuvant chemotherapy 98 Example, for the same period group. The general data, overall survival, progression-free survival rate, acute and chronic adverse reactions of the two groups were compared and analyzed, and the prognostic factors of locally advanced NPC were analyzed. Results: The 5-year progression-free survival rate (70.7%, 67.3%, P = 0.591) and overall survival rate (78.3%, 78.6%, P = 0.635) in the induction group and the concurrent group were not significantly different. There was no significant difference in recurrence or metastasis between the two groups (29.3%, 35.7%, P = 0.435). Compared with the same period, induction group Ⅲ ~ Ⅳ grade leukopenia and nausea and vomiting was significantly lower, the difference was statistically significant (both P <0.05); two groups were no significant difference in the incidence of late adverse reactions (P> 0.05). Multivariate analysis showed that age (P = 0.000) and N stage (P = 0.003) were independent predictors of overall survival in patients with locally advanced NPC. Conclusion: Induction chemotherapy plus radiotherapy and concurrent chemoradiotherapy plus adjuvant chemotherapy have the same effect on patients with locally advanced nasopharyngeal carcinoma, and the incidence of acute adverse reactions associated with chemotherapy and radiotherapy is low. Therefore, induction chemotherapy plus radiotherapy may be more effective and safe treatment.