鼻咽癌咽旁间隙侵犯对预后的影响  

TX Prognostic effect of paranasopharyngeal space extension of naopharyngeal carcinoma

作　　者：吴少雄[1] 曾智帆[1] 赵充[1] 胡永红[1] 夏云飞[1] 张恩罴[1] 

机构地区：[1]中山医科大学肿瘤防治中心放疗科

出　　处：《癌症》1998年第4期286-289,共4页Chinese Journal of Cancer

摘　　要：目的：探讨鼻咽癌咽旁间隙侵犯程度与预后的关系。方法：２１９例初诊鼻咽癌经ＣＴ扫描后将咽旁间隙侵犯程度分为：０级：无侵犯；Ⅰ级：轻度侵犯；Ⅱ级：重度侵犯。应用ＫａｐｌａｎＭｅｉｅｒ方法和Ｃｏｘ模型对放疗后５年的局控率、无远处转移生存率、无瘤生存率及影响预后因素进行分析和评价。结果：咽旁０、Ⅰ、Ⅱ级侵犯的５年无瘤生存率分别为６９９１％、６０７２％、３２１３％，后者明显低于前两者（Ｐ≤０．０００３），而前两者比较则无差异（Ｐ＝０．４７３６）；Ⅱ级侵犯的５年鼻咽局控率（６８７％）、颈部局控率（７６４％）和无远处转移生存率（５８５％）也明显低于０级（分别为８９９％、９５３％和８８０％）和Ⅰ级（分别为８３７％、９５８％和８１５％），统计学上有显著差异。多因素Ｃｏｘ模型显示Ｎ分期、咽旁侵犯程度和副鼻窦（包括海绵窦）侵犯是影响预后的显著性因素。结论：咽旁间隙重度（Ⅱ级）侵犯是鼻咽癌预后较差的重要影响因素之一。Objective:To evaluate the prognostic effect of paranasopharyngeal space extension of nasopharyngeal carcinoma.Methods:Two hundreds and nineteen patients with newly diagnosed nasopharyngeal carcinoma receiving CT scan before radiotherapy were analyzed.Tumor extension into the paranasopharyngeal space was graded as:0 (no extension), 1(mild extension) and 2 (extensive extension). Relapse free, distant metastasis free (DMFa) and disease free survival (DFS) in 5 years after the treatment were estimated using the KaplanMeier method.Cox model was also performed to adjust prognostic factors. Results:The 5year DFS rates for Grade 0,1,2 paranasopharyngeal extension were 69.91%,60.72%,32.13%,respectively.The main difference was between Grade 2 and Grade 0 or 1 extension(P≤0.0003),but no difference was noticed between Grade 0 and 1 extension(P=0.4736).Grade 2 extension had a lower 5year nasopharynx control rate (68.7%),neck control rate (76.4%)and DMFS rate (58.5%) as compared with Grade 0 (89.9%,95.3% and 88.0%,respectively)or Grade 1(83.7%,95.8% and 81.5%,respectively),the differences were statistically significant between the former and the latter.Multivariate Cox model analysis showed that N classification,paranasopharyngeal extension and paranasal sinuses (including cavernous sinus) involvement were significant factors in predicting DFS. Conclusions:Extensive paranasopharyngeal extension (Grade 2) was an important prognostic factor with poorer treatment outcome.It was reasonable that it was classified as T3 classification in 92's nasopharyngeal carcinoma clinical classification.　

关 键 词：鼻咽肿瘤 放射疗法 咽旁间隙侵犯 预后 

分 类 号：R739.63[医药卫生—肿瘤]