148例儿童及青少年鼻咽癌疗效及预后因素分析  

The outcome and prognosis factors of adolescent nasopharyngeal carcinoma treated in a single institute- an analysis of 148 patients

作　　者：裴苏[1] 高黎[1] 易俊林[1] 黄晓东[1] 罗京伟[1] 李素艳[1] 肖建平[1] 张世平[1] 王凯[1] 曲媛[1] 徐国镇[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所放疗科,北京100021

出　　处：《中华放射肿瘤学杂志》2011年第3期175-180,共6页Chinese Journal of Radiation Oncology

摘　　要：目的分析儿童及青少年鼻咽癌的临床特征，治疗疗效及预后因素。方法1990～2009年收治的20岁以下鼻咽癌患者148例，1992年福州分期Ⅱ期11例，Ⅲ期48例，Ⅳ期88例，1例分期不明；国际抗癌联盟2002年分期Ⅱ期8例，Ⅲ期58例，Ⅳ期81例，1例分期不明。单纯放疗94例，放疗和化疗综合治疗54例。结果中位随诊时间为44．5个月。全组5年总生存率、局部控制率和无远处转移生存率分别为82．9％、85．1％、78．6％。42例治疗后失败，16例局部区域复发，29例远处转移，其中3例同时出现局部区域复发和远处转移，骨转移为最常见的部位。单因素分析显示T。期、鼻咽剂量〈70Gy是总生存率的不良预后因素（x2=4．08、5．61、5．30，P=0．043、0．018、0．021），鼻咽剂量〈70Gy是局部控制率的不良预后因素（x2=7．32，P=0．007），病史I〉6个月是无远转生存率的不良预后因素（x2=4．24，P=0．039）。多因素分析显示国际抗癌联盟2002年分期T4期、鼻咽剂量〈70Gy是5年总生存率的独立预后因素（x2=5．73、5．56，P=0．017、0．018），鼻咽剂量〈70Gy是局部控制率的独立预后因素（x2=5．81，P=0．016）。结论儿童及青少年鼻咽癌治疗疗效好，放疗剂量可与成年人相同．减少远处转移和减少严重晚期不良反应将是以后努力的目标。Objective To evaluate the clinical characteristics, outcome and prognostic factors of adolescent nasopharyngeal carcinoma. Methods Between Jan 1990 and Dec 2009, totally 148 pathological confirmed nasopharyngeal carcinoma （NPC） patients with age ≤ 20 years were treated in our hospital, including stage Ⅱ 8 , stage Ⅲ 58, stage Ⅳ 81, and unknown 1 when restaged by TNM system （UICC 2002） , ninty-four （63.5%） patients were treated with radiotherapy alone, 54 （36.5%） patients were treated with radiotherapy combined with cisplatin-based chemotherapy. Results The median follow-up time for all patients was 44.5 months. The 5-year overall survival （OS）, local-regional control （LRC）and distant metastasis-free survival （DMFS） rates were 82.9% ,85.1% and 78.6%. There were 42 patients （28.4%） failed with 16 regional recurrence and 29 distant metastasis, and 3 with both;bone metastasis was the most common site of distant metastasis （22/29）. In univariate analysis, the adverse prognostic factors for OS were stage T4 （ X2 = 5.61,P = 0.018 ）, radiation dose 〈 70 Gy （ X2 = 5.30, P = 0. 021 ）, for LRC was radiation dose 〈70 Gy and for distant metastasis-free survival was the disease history ≥6month（ X2 = 4.24,P = 0. 039）. In multivariate analysis, radiation dose 〈 70 Gy and stage T4 were the independent prognostic factors for OS（x2 =5.73,5.56,P =0. 017,0. 018） ,for LRC was radiation dose 〈70 Gy（x2 =5.81 ,P = 0. 016）. Conclusions The outcome of the present series was excellent, total nasopharyngeal radiation dose less than 70 Gy is inappropriate. Reduce the distant metastasis and late toxicities were the future direction for the treatment of adolescent nasopharyngeal carcinoma.

关 键 词：青少年 鼻咽肿瘤/放射疗法 预后 

分 类 号：R739.63[医药卫生—肿瘤]