基于磁共振成像鼻咽癌临床分期的研究——对'92分期改进的建议  

Clinical Staging of Nasopharyngeal Carcinoma Based on MRI:Suggestions for Improving the Chinese '92 Staging System

作　　者：毛燕萍[1] 洪明晃[1] 孙颖[1] 梁少波[1] 李立[1] 刘立志[1] 唐玲珑[1] 曹素梅[1] 林爱华[2] 卢泰祥[1] 刘孟忠[1] 马骏[1] 

机构地区：[1]华南肿瘤学国家重点实验室 [2]中山大学北校区公共卫生学院医学统计与流行病学系,广东广州510080

出　　处：《癌症》2007年第10期1099-1106,共8页Chinese Journal of Cancer

基　　金：国家自然科学基金项目(No30470505);广东省科技计划项目(No2004B50301005);广州市科技局科技攻关引导项目(No2004Z3-E0451)~~

摘　　要：背景与目的:"92分期系统临床应用15年来,鼻咽癌的诊断和治疗水平发生了明显的改变。本研究旨在通过对基于现代诊断和治疗模式下大宗病例的鼻咽癌进行分期因素的探讨,为"92分期的改进提供参考。方法:收集2003年1月至2004年12月间中山大学肿瘤防治中心放疗科收治、经病理证实、无远处转移的初诊鼻咽癌924例,所有病例治疗前均行鼻咽和颈部MRI检查。采用归纳法分析"92分期中T因素之间的相互关系。N分期因素的筛选采用Cox风险比例模型进行多因素分析。根据临床分期的原则,采用风险一致性、风险差异性、预后预测及分布均衡性等指标对分期进行评价。结果:"92-T分期因素中,颈椎前软组织、软腭、翼腭窝及眼眶受侵时,均100%合并其它同一期别或更高期别的T因素受侵,91.3%(282/309)颈动脉鞘区肿物占据合并其它T3因素受侵,85.3%(64/75)单组颅神经受侵合并其他T4因素受侵。T3颈动脉鞘区肿物占据组(HR=1.635,95%CI:0.987～2.764)与T2组(HR=1.524,95%CI:0.910～2.368)的局部复发风险比较接近;T3单一颅底骨质受侵组(HR=3.567,95%CI:1.398～11.278)、广泛颅底骨质受侵组(HR=3.891,95%CI:1.449～10.449)及T4单纯蝶窦受侵组(HR=3.613,95%CI:1.437～11.854)局部复发风险比较接近;T3单组颅神经受侵组(HR=5.849,95%CI:2.069～14.500)和T4除蝶窦外受侵组(HR=6.618,95%CI:2.499～17.525)局部复发风险比较接近。多因素分析结果显示,淋巴结转移的水平、侧数是影响鼻咽癌远处转移的独立预后因素。由此,依据分期标准简洁的要求,删除软腭、颈椎前软组织、翼腭窝及眼眶等因素。依据风险一致性原则,将咽旁间隙包括茎突前间隙及颈动脉鞘区侵犯定义为T2,颅底骨质包括翼突区侵犯定义为T3,蝶窦受侵定义为T3,颅神经侵犯定义为T4。依据多因素分析结果,N分期考虑淋巴结侧数及水平。结论:本研究推荐的、基于磁共振成像的T、N�BACKGROUND ＆ OBJECTIVE： Since the introduction of the Chinese ＇92 staging system of nasopharyngeal carcinoma （NPC）, the diagnostic technology and therapeutic modality for NPC have been advanced obviously over the past 15 years. This study was to evaluate the staging parameters for NPC in a large cohort based on modern diagnostic and therapeutic modality to provide suggestions for improving the Chinese ＇92 staging system. METHODS： Between Jan. 2003 and Dec. 2004, 924 consecutive patients with newly diagnosed, nondisseminated biopsy-proven NPC, treated at Cancer Center of Sun Yat-sen University, were enrolled. All patients received magnetic resonance imaging （MRI） scan of the neck and nasopharynx before treatment. Induction was applied to evaluate the correlations among different T parameters. Cox regression model was used to investigate the prognostic values of different N parameters. According to the principle of the staging system, the indices of hazard consistency, hazard discrimination, prognostic value, and distribution were used to evaluate the proposed staging system. RESULTS： According to the Chinese ＇92 T classification, all cases of involvement of the prevertebra muscle, soft palate, pterygopalatine fossa, and orbit were incorporated with erosion of other parameters that belonged to the same or more advanced subgroup; 282 （91.3%） of the 309 cases of carotid sheath involvement were incorporated with erosion of other T3 parameters; 64 （85.3%） of the 75 cases of single anterior or posterior group of cranial nerve involvement were incorporated with erosion of other T4 parameters. The hazard ratios （HR） of local relapse for T3 stage with carotid sheath involvement [HR=1.635, 95% confidence interval （CI）： 0.987-2.764] and T2 stage （HR=1.524, 95% CI： 0.910-2.368） were similar. The hazard ratios of local relapse for T3 stage with single site of skull base erosion （HR=3.567, 95% CI： 1.398-11.278）, T3 stage excluding single site of skull base erosion （HR=3.891,

关 键 词：鼻咽肿瘤 磁共振成像 肿瘤分期 分期因素 

分 类 号：R739.63[医药卫生—肿瘤]