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中国癌症防治杂志

中国癌症防治杂志 ›› 2025, Vol. 17 ›› Issue (3): 366-371.doi: 10.3969/j.issn.1674-5671.2025.03.15

• 头颈部肿瘤专栏 • 上一篇    下一篇

TPF和GP方案诱导化疗联合同步放化疗治疗局部晚期鼻咽癌的疗效及安全性比较

  

  1. 广西医科大学附属肿瘤医院放疗科；区域性高发肿瘤早期防治研究教育部重点实验室（广西医科大学）
  • 出版日期:2025-06-25 发布日期:2025-07-10
  • 通讯作者: 曲颂， E-mail：daisyqs2002@163.com
  • 基金资助:
    广西科技计划项目（桂科AB29069065）；广西区域性高发肿瘤早期防治研究重点实验室自主课题（GKE-22202411）

Comparative efficacy and safety of TPF versus GP induction chemotherapy combined with concurrent chemoradiotherapy in locally advanced nasopharyngeal carcinoma

  • Online:2025-06-25 Published:2025-07-10

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摘要： 目的 比较多西他赛、顺铂、5⁃氟尿嘧啶（TPF）方案与吉西他滨、顺铂（GP）方案在局部晚期鼻咽癌患者中作为诱导化疗与同步放化疗联合使用时的近期疗效、生存预后及不良反应。方法 本研究为回顾性队列研究，纳入了2016年1月至2018年12月，在广西医科大学附属肿瘤医院接受TPF或GP方案诱导化疗后，再进行同步放化疗的局部晚期鼻咽癌患者。采用χ2检验比较两组治疗方案在近期疗效和不良反应上的差异，采用Log⁃rank检验和Cox比例风险回归模型比较两组的总生存期(overall survival, OS)、无进展生存期(progression⁃free survival, PFS)、无局部复发生存率(local recurrence⁃free survival, LRFS)以及无远处转移生存期(distant metastasis⁃free survival, DMFS)。结果 共273例患者被纳入分析，其中GP组56例，TPF组217例。在诱导化疗或同步放化疗后，TPF组与GP组的客观缓解率无明显差异（均P>0.05）。两组在1年、3年和5年OS、PFS、LRFS和DMFS方面均无显著性差异（均P>0.05），这些结果在使用Cox比例风险回归模型调整协变量后仍然保持一致。在安全性方面，GP组在诱导化疗期间的贫血（Ⅰ~Ⅱ级：80.4% vs 50.7%；Ⅲ~Ⅳ级：8.9% vs 2.8%）和血小板减少（Ⅰ~Ⅱ级：10.7% vs 1.4%；Ⅲ~Ⅳ级5.4% vs 0）的发生率均显著高于TPF组（均P<0.05）。在同步放化疗期间，GP组Ⅲ~Ⅳ级血小板减少症发生率显著高于TPF组（17.9% vs 3.7%，P<0.001）。结论 对于局部晚期鼻咽癌患者，采用TPF或GP方案进行诱导化疗，随后进行同步放化疗，具有相似的治疗效果。然而，GP方案与更高的血液毒性发生率相关。

关键词: 鼻咽癌, 诱导化疗, 放射治疗, 不良反应, 预后

Abstract: Objective To evaluate the short⁃term efficacy, survival outcomes, and adverse effects of TPF regimen (docetaxel，cisplatin，and 5⁃fluorouracil) in comparison to the GP  regimen (gemcitabine and cisplatin) when used as induction chemotherapy in conjunction with concurrent chemoradiotherapy for patients with locally advanced nasopharyngeal carcinoma. Methods This retrospective cohort study enrolled patients with locally advanced nasopharyngeal carcinoma who received induction chemotherapy with either the TPF or GP regimen, followed by concurrent chemoradiotherapy, at the Guangxi Medical University Cancer Hospital from January 2016 to December 2018. The χ2 test was used to assess differences the short⁃term efficacy and adverse effects between the two treatment groups. The Log⁃rank test and Cox proportional hazards regression model were applied to compare overall survival (OS), progression⁃free survival (PFS), local recurrence⁃free survival (LRFS), and distant metastasis⁃free survival (DMFS) between the groups. Results A total of 273 patients were included in the analysis, with 56 in the GP group and 217 in the TPF group. Following induction chemotherapy or concurrent chemoradiotherapy, the objective response rates did not differ significantly between the TPF and GP groups (all P>0.05). Similarly, no significant differences were observed between the groups in 1⁃, 3⁃, and 5⁃year OS, PFS, LRFS, and DMFS (all P>0.05). These results remained consistent after adjusting for covariates using the Cox proportional hazards regression model. In terms safety, the GP group demonstrated a significantly higher incidence of anemia (grade Ⅰ-Ⅱ: 80.4%  vs 50.7%; grade Ⅲ-Ⅳ: 8.9% vs 2.8%) and thrombocytopenia (grade Ⅰ-Ⅱ: 10.7% vs 1.4%; grade Ⅲ-Ⅳ: 5.4% vs 0) during induction chemotherapy compared to the TPF group (all P<0.05). During concurrent chemoradiotherapy, grade Ⅲ-Ⅳ thrombocytopenia was more prevalent in the GP group than in the TPF group (17.9% vs 3.7%, P<0.001). Conclusions In patients with locally advanced nasopharyngeal carcinoma, induction chemotherapy utilizing either the TPF or GP regimen followed by concurrent chemoradiotherapy had comparable therapeutic efficacy. However, it is noteworthy that the GP regimen was associated with a higher incidence of hematologic toxicity.

Key words: Nasopharyngeal carcinoma, Induction chemotherapy, Radiotherapy, Adverse effects, Prognosis

中图分类号: 

  • R739.63