Stakeholder theory and game theory were applied to analyze the stakeholders,role definition,participation,interest,power,position and the shift of positions under different conditions in the negotiation.Use SPSS 17.0 to analyze the database of NCMS in 2009～2010 in three counties of Hubei province,and then employ Linear programming method to do a case study of price negotiation.It is difficult to meet all stakeholders' expectations under the current condition of catastrophic disease insurance pooled at municipal-level.Medical cost differences in tertiary hospitals at provincial level are small for different regions,which constitute a basis for price negotiation at provincial level.Besides,the negotiation at province level can effectively address the conflicts of interest,and promote the negotiations.Negotiation at provincial level for such diseases,and formulating unified pricing standards for multi-wins.

This paper proposed the idea of building the applied anatomical experiment and research platform for surgical postgraduates with professional degree,establishing double-tutorial system and applying applied anatomical teaching in basis course learning,clinical skill training and research capacity cultivating after analyzing the reasons of poor applied anatomical background of surgical postgraduates with professional degree.These ideas were intended to improve the cultivation quality.

ObjectiveTo evaluate the therapeutic efficacy and prognostic factors of intensity-modulated radiotherapy combined with chemotherapy for early-stage nasopharyngeal carcinoma patients in northwest China. MethodsFrom January 2006 to December 2009,58 patients with early-stage nasopharyngeal carcinoma were treated with IMRT in Xijing hospital,the clinical data were analyzed retrospectively.Survival rates was calculated by the Kaplan-Meier method and the differences was compared by the Logrank test.Univariate analysis method was use to identify all significant factors.ResultsThe follow-up rate was 100％.The follow-up time of 46 patients was more than 3 years.The 1-,2 and 3-year survival were 98％,94％ and 91％,respectively.The 3-year overall survival (OS),local recurrence-free survival (LRFS),distant metastasis-free surv ival (DMFS) for T1N0-1,T2N0 and T2N1 stage were 100％,100％,100％ and 74 ％,81％,87 ％,respectively ( x2 =5.74,P =0.01 ; x2 =4.95,P =0.03 ; x2 =4.24,P=0.04).The 3-year OS,LRFS,DMFS for IMRT combined with chemotherapy and IMRT alone were 100％,100％,100％ and 85％,85％,88％ respectively ( x2 =4.02,P =0.04; x2 =4.12,P =0.03 ; x2 =4.84,P =0.02).In T2N1 stage,IMRT combined with chemotherapy and IMRT alone were 100％,100％,100％ and 79％,79％,80％ respectively (x2 =5.28,P =0.03 ;x2 =4.84,P =0.04;x2 =4.72,P =0.04).In univariate analysis,N stage,clinical stage,IMRT combined with chemotherapy were significantly associated with the survival ( x2 =5.39,P =0.02 ; x2 =5.74,P =0.01 ; x2 =4.02,P =0.04).Conclusions In all early-stage nasopharyngeal carcinoma,T2N1 stage is a sub-group of high risk of distant metastasis.Combination of IMRT and chemotherapy may improve the LRFS,DMFS and OS in those patients.

ObjectiveTo evaluate the long term outcomes, toxicities and prognostic factors of the patients in Northwest China with nasopharyngealcarcinoma (NPC)treated by intensity-modulated radiotherapy (IMRT). MethodsFrom January 2006 to December 2009, 133 NPC Patients were treated by IMRT in Xijing Hospital, the Fourth Military Medical University. There were 22 treated by radiotherapy alone, 111 treated by platinum-based current chemo-radiothreapy. The prescription dose to the gross tumor volume was 66 - 76. 6 Gy/30 - 33 fractions, positive lymph nodes was 66. 0 - 72. 4 Gy/30 - 33 fractions.The higher and lower risk clinical target volume were irradiated with 56. 0 - 63. 5 Gy/28 - 33 fractions and 50. 4 -53. 2 Gy/28 fractions respectively. ResultsThe follow-up rate was 97. 7％. Follow-up time more than 2years,3years were 37cases ,44cases. The l-,2-and 3-year overall survival (OS) were 93. 8％, 88. 3％and 83.2％ ; local control rate were 99. 2％ ,95.4％ and 95.4％ ; regional control rate ( RC ) were 99. 2％,96. 8％ and 96.8％ ; and distant metastasis-free rate (DMFR) were 82. 8％, 79. 8％ and 79. 8％ ; the disease-free survival (DFS) were 84. 3％ ,76. 7％ and 76. 7％, respectively. Multivariate analyses revealed that N stage, age and anemia before radiotherapy were independent predietors for OS (x2 =5.56,9. 10,4.89,P=0. 018,0.003,0.027), and N stage was also independent predictors for DFS (x2 =8.98,P=0.003).Thegrade 3acutetoxicitiesweremueositis(34.7％),xerostomia(20. 1％ ), skin reaction ( 1.4 ％ ) and leucocytopenia ( 1. 4 ％ ). No grade4 acute and late toxieities were detected. Conclusions IMRT with or without chemotherapy achieved good long term survival in nasopharyngeal carcinoma treated by intensity-modulated radiotherapy, especially in LC and RC. Distant metastasis becomes the main treatment failure.N stage, age, and anemia before radiotherapy were the main prognostic factors in nasopharyngeal cancer patients.

Objective: To retrospectively analyze the characteristics of nasopharyngeal carcinoma, long-term efficacy, adverse reactions of intensity-modulated radiotherapy (IMRT) in non-endemic northwest China and summarize the experience of IMRT in the treatment of nasopharyngeal carcinoma in the past decade. Methods: Clinical data of 658 patients newly diagnosed with nasopharyngeal carcinoma without distant metastasis admitted to First affiliated hospital from January 2006 to December 2016 were retrospectively analyzed. All patients were treated with IMRT. The survival analysis was performed by Kaplan-Meier method. The multivariate analysis was conducted with Cox’s regression model. Results: In non-endemic northwest China, a large proportion of patients were newly diagnosed with locally advanced nasopharyngeal carcinoma, and a majority of them were pathologically characterized as differentiated subtypes. The 5-year overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) rates were 75.7%, 70.1%, 91.2%, 97.0% and 81.0%, respectively. Multivariate analysis showed that age, pathological type, nasopharyngeal tumor volume>23 cm³ and neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of DFS (all P<0.05). Age, pathological type, neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of OS (all P<0.05). N stage and neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of DMFS (both P<0.05). Conclusions Similar clinical efficacy has been achieved in terms of IMRT for nasopharyngeal carcinoma in non-endemic northwest China compared with that in endemic area. Induction chemotherapy combined with concurrent radiochemotherapy can provide clinical benefits for patients with locally advanced nasopharyngeal carcinoma in non-endemic area.