鼻咽癌咽旁间隙侵犯对预后的影响  

Prognostic influence of parapharyngeal space involvement in nasopharyngeal carcinoma

作　　者：孙折玉[1] 麦海强[1] 谢传淼[2] 赵正军[1] 齐斌[1] 洪明晃[1] 郭翔[1] 莫浩元[1] 

机构地区：[1]中山大学肿瘤防治中心鼻咽科,广东广州510060 [2]中山大学肿瘤防治中心影像介入科,广东广州510060

出　　处：《中华肿瘤防治杂志》2006年第10期756-759,共4页Chinese Journal of Cancer Prevention and Treatment

基　　金：华南肿瘤学国家重点实验室基金(985-2)

摘　　要：目的:探讨鼻咽癌咽旁间隙受侵对预后的影响。方法:咽旁间隙的侵犯程度根据SO线(茎突到枕骨大孔中线后缘中点连线)进行划分,无咽旁侵犯记录为0级,SO线以前的咽旁侵犯记录为1级,SO线以后记录为2级。KaplanMeier法计算总生存率、无瘤生存率、无局部复发生存率和无远处转移生存率,Cox模型进行预后的多因素分析。结果:176例患者中,咽旁受侵的发生率为81.8%,其中1级为70.1%,2级为29.9%。咽旁间隙受侵与颈部淋巴结转移有明显相关性,χ2=8.185,P=0.0040。咽旁受侵0、1和2级患者5年总生存率分别为90.2%、75.1%和51.2%,logrank检验值为16.45,P=0.0003;5年无瘤生存率分别为87.2%、71.5%和53.3%,logrank检验值为10.87,P=0.0044;5年无远处转移生存率分别是93.7%、82.2%和62.7%,logrank检验值为9.41,P=0.0091。多因素分析显示,咽旁受侵不是独立的预后因素,但严重咽旁间隙侵犯是影响鼻咽癌总生存、无瘤生存及远处转移的独立预后因素。结论:咽旁侵犯应该根据程度进行划分,单纯咽旁侵犯的有无不能独立的影响预后,但根据咽旁侵犯程度进行分级后,严重的咽旁侵犯是影响总生存、无瘤生存和远处转移的独立预后因素。OBJECTIVE： The study was conducted to evaluate the prognostic influence of parapharyngeal space （PPS） involvement in patients with nasopharyngeal carcinoma. METHODS： Using semiquantitative method, tumor extension into the parapharyngeal space was graded as： 0： no extension; 1： extension not exceed the SO line; and 2：-extension exceed the SO line. Overall survival （OS）, relapse-free survival （RFS）, freedom from local relapse （FLR）, and freedom from distant metastasis survival （FDM） rates were estimated using Kaplan-meier method. Cox regression was also performed to adjust for prognostic factors. RESULTS： The incidence of PPS involvement was 81.8%. Of these patients, 70. 1%had grade 1, and 29.9% had grade 2. PPS involvement correlated well with lymphadenopathy （X^2= 8. 185, P = 0. 004 0）. The 5-year overall survival rates for Grade 0, 1, and 2 extension were 90.2%,75.1%, and 51.2%, respectively （log-rank = 16. 45, P = 0. 000 3）. The 5-year disease-free survival rates for Grade 0, 1, and 2 extension were 87.2%, 71.5%, and 53.3%, respectively （log-rank= 10.87, P=0. 004 4）. The 5-year freedom from distant metastasis survival rates for Grade 0, 1, and 2 extension were 93.7%, 82.2%, and 62. 7%, respectively （log-rank=9.41, P=0. 0091）. Advanced PPS involvement showed stronger prognostic value than PPS invasion. In multivariate analysis, only advanced PPS involvement had independent predictive value for overall survival, disease-free survival, and freedom from distant metastasis survival rates. CONCLUSIONS： We recommend that the extent of PPS should be clarified and stratified. In view of the prognostic significance, advanced PPS involvement showed stronger predictive value than PPS invasion. Advanced PPS involvement is associated with poorer survival and distant metastasis.

关 键 词：鼻咽肿瘤/病理学 鼻咽肿瘤/放射疗法 肿瘤侵润 预后 

分 类 号：R739.63[医药卫生—肿瘤]