1837例鼻咽癌疗效的回顾性分析  

Treatment results of nasopharyngeal carcinoma ： a retrospective analysis of 1837 cases in a single institute

作　　者：高云生[1] 胡超苏[1] 应红梅[1] 朱国培[1] 孔琳[1] 何霞云[1] 许婷婷[1] 王孝深[1] 袁晶[1] 吴素琴[1] 张有望[1] 刘泰福[1] 

机构地区：[1]复旦大学附属肿瘤医院放疗科复旦大学上海医学院肿瘤学系复旦大学鼻咽癌诊治中心,上海200032

出　　处：《中华放射肿瘤学杂志》2008年第5期335-339,共5页Chinese Journal of Radiation Oncology

摘　　要：目的总结我院鼻咽癌常规放疗的疗效和经验。方法回顾性分析2000年1月至2003年12月收治的1837例经病理证实的初治鼻咽癌患者。年龄8～87岁（48岁），男1403例，女434例，男：女=3．2：1。1992年福州分期T1、T2、T3、T4期分别为364、995、274、204例，N0、N1、N2、N3期分别为412、801、514、110例。Ⅰ、Ⅱ、Ⅲ、ⅣA、ⅣB期分别为77、777、668、291、24例。959例局部晚期患者中，单纯放疗363例，综合治疗596例。855例接受以顺铂为基础化疗。鼻咽原发病灶主要采用”Co＇y线、6MVx线常规分割照射，1．8～2．0Gy／次，总剂量30．6～74．0Gy。常规放疗结束后如鼻咽镜或CT提示有肿瘤残存者，则通过耳后野、颅底野、后装及适形加量6～20Gy。颈部放射源用^60Co γ线、180kV X线和9MeV电子束，N0期患者仅照射上颈部，有颈部转移者照射全颈。预防总剂量50～56Gy，根治总剂最60～68Gy。结果中位随访54个月，5年总生存率、无瘤生存率、无复发生存率、无远处转移生存率分别为67．42％、63．25％、86．47％和80．31％。Ⅰ、Ⅱ、Ⅲ、ⅣA、ⅣB期的5年生存率分别为88％、74．8％、65．9％、52．4％、20％。Ⅲ＋ⅣA期959例中单纯放疗、综合治疗的5年生存率分别为63．7％和60．7％（P=0．216）。Ⅲ期668例中单纯放疗（279例）和综合治疗（389例）的5年生存率分别为65．2％和66．5％（P=0．810）。单因素分析显示与总的生存有关的因素有性别、T分期、N分期、M分期、92福州分期、贫血、治疗前LDH水平、化疗、后装治疗及面颈联合野。多因素Cox回归分析屁示性别、T分期、N分期、92福州分期与总生存有关。结论鼻咽癌常规治疗5年生存率达67．4％，总生存与性别、T分期、N分期、M分期、福州分期、贫血等有关。Objective To summarize our experience and treatment results of nasopharyngeal carcinoma treated in a single institution. Methods From Jan. 2000 to Dec. 2003,1837 patients with histologi- cally proven nasopharyngeal carcinoma（NPC） were retrospectively analyzed. The disease was staged accord- ing to the Fuzhou stage classification. 885 patients received cisplatin （DDP） based chemotherapy. All patients received radiotherapy to the nasopharynx and neck. The dose was 30.6-74.0 Gy, 1.8-2.0 Gy per fraction over 3.5-8.0 weeks to the primary site with ^60Co γ rays or 6 MV X-rays. The dose to lymph nodes was 60-68 Gy. The residual disease was boosted by ^192Ir afterloading brachytherapy, small external beam fields, conformal radiotherapy, or X-knife. Results The median follow-up time was 54 （3-90） months. The 5- year overall survival （OS） , disease-free survival （ DFS ） , relapse-free survival （ RFS ） and distant metastasis- free survival（DMSF） rates were 67.42% ,63.25% ,86.47% and 80.31% ,respectively. Clinical stage was the most significant prognostic factor,and OS was 88% ,74.8% ,65.9% ,52.4% and 20% for stage Ⅰ , stage Ⅱ ,stage Ⅲ ,stage ⅣA and stage Ⅳ B, respectively. Gender,T, N and TNM stage were the significant prognostic factors of OS in multivariate analysis. Conclusions For NPC patients,the 5-year OS of 67.4% is a- chieved by conventional radiotherapy technique in our institution. Both univariate and multivariate analysis shows that gender and clinical stage are the significant prognostic factors of OS.

关 键 词：鼻咽肿瘤 放射治疗 预后因素分析 疗效 

分 类 号：R686[医药卫生—骨科学]