鼻咽癌临床分期因素意义的探讨  

Evaluation of the prognostic factors of tumor staging for nasopharyngeal carcinoma

作　　者：宗井凤[1] 马骏[1] 唐玲珑[1] 刘立志[2] 孙颖[1] 黄莹[1] 林爱华[3] 卢泰祥[1] 

机构地区：[1]中山大学肿瘤防治中心放疗科华南肿瘤学国家重点实验室,广州510060 [2]中山大学肿瘤防治中心影像科 [3]中山大学公共卫生学院医学统计与流行病学系

出　　处：《国际肿瘤学杂志》2006年第1期71-75,共5页Journal of International Oncology

基　　金：国家自然科学基金资助项目(30470505);广东省科学技术厅基金资助项目(2004850301005);广州市科技局科技攻关引导项目(2004Z3-E0451)

摘　　要：目的通过对大宗鼻咽癌病例的临床分期因素分析,探讨随着影像学、放疗技术的进展及综合治疗策略的改进,鼻咽癌分期因素预测预后变化情况的意义。方法回顾性分析无远处转移初治鼻咽癌患者749例,根据’92分期标准,以疾病相关死亡、局部复发及远处转移等作为观察指标,对性别、年龄、T、N分期等因素作单因素和多因素分析。结果Ⅰ、Ⅱ、Ⅲ、Ⅳ期的病例数分别占4．0％、29．8％、33．6％和32．6％,各临床分期疾病相关生存曲线能较好地分开。单因素分析显示,所有与T和N分期有关的因素均有统计学意义;多因素分析显示,疾病相关死亡的独立预后因素有性别、年龄、口咽侵犯、副鼻窦侵犯、咽旁间隙受侵、颅神经受损、颅内侵犯及颈部淋巴结转移的部位、侧数等。局部复发的独立预后因素包括副鼻窦受侵、颅底骨质破坏、咽旁间隙受侵和颅内侵犯等。远处转移的独立预后因素包括咽旁间隙受侵、颅内侵犯、颈部淋巴结转移的部位、侧数等。结论’92分期标准基本能区分不同预后的患者,各临床分期的病例数分布较为合理,鼻咽癌分期因素的预后分析结果可为各种临床研究设计提供依据。T分期中可将各种颅神经受损情况归为同一期,使分期简单化。N分期中则应考虑颈部转移淋巴结单双侧的信息。Objective With the development of imaging, radiation techniques, and the strategy of combined therapy, a large series of nasopharyngeal carcinoma （NPC） patients was conducted to analyze the prognostic significance based on the factors of staging. Methods 749 patients with untreated nondisseminated NPC who had enhanced computed tomography （CT） of the nasopharynx and the whole neck were retrospectively studied. According to the Chinese 1992 staging system, by using the disease specific deaths, local recurrence and distant metastasis as endpoints, gender, age, and detail characters of T/N classification were included in the univariate and multivariate analysis. Results The percentages of patients with Stage Ⅰ - Ⅳ disease were 4. 0% ,29. 8% ,33.6% and 32. 6% ,respectively. Disease specific survival curves among different stage groups were well segregated. Univariate analysis showed that all factors of T/N classification were of statistical significance. Multivariate analysis showed that independently significant prognostic factors for disease specific death were patient age, gender, oropharynx extention, paranasal sinus involvement, parapharyngeal infiltration, cranial nerve involvement, intracranial involvement, the lymph node level and laterality. Independently significant prognostic factors for local recurrence were paranasal sinus involvement, skull base erosion, parapharyngeal infiltration and intracranial involvement. Prognostic factors that independently impact distant metastasis were parapharyngeal infiltration, intraeranial involvement, the lymph node level and laterality. Conclusion Patients with different survivalstates could be well divided by the Chinese 1992 staging system. Patient distribution was rational. Clinical researches could be conducted based on the results of the prognostic analysis of factors for staging. Patients with intracranial nerve involvement could be classified as the same T classification for simpler and easier application. The information of lymph node laterality should

关 键 词：鼻咽肿瘤 预后分析 肿瘤分期 体层摄影术 

分 类 号：R739.63[医药卫生—肿瘤]