鼻咽癌咽旁侵犯程度划分方法对预后的影响  

Prognostic significance of the various classifications for parapharyngeal space involvement in nasopharyngeal carcinoma

作　　者：麦海强[1] 谢传淼[2] 陈秋燕[1] 邱慧芝[1] 温月凤[1] 刘怀[1] 钟宗良[1] 郭翔[1] 莫浩元[1] 

机构地区：[1]华南肿瘤学国家重点实验室中山大学肿瘤防治中心,鼻咽科,广东广州510060 [2]华南肿瘤学国家重点实验室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》2011年第17期1333-1337,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金(81072226);“863计划”子课题(2006AA02A404);广东省科委项目(2007B060401064);广东省医学科研基金(B2006063);广州市科委项目(2007Z1-E4022);中央高校基本科研业务费专项资金

摘　　要：目的:探讨咽旁侵犯对鼻咽癌预后的影响,并对多种咽旁侵犯程度的划分方法进行比较,以寻求能较好反映预后的划分。方法:2000-01-2000-07经病理确诊的初治M0期鼻咽癌患者176例纳入研究。根据4种咽旁划分方法(闵氏、Sham氏、肖氏和Heng氏建议的划分)对咽旁间隙的侵犯程度划分,前瞻性研究其对鼻咽癌预后的影响。结果:鼻咽癌咽旁侵犯的发生率为81.8%(144/176)。有咽旁侵犯和无咽旁侵犯的5年总生存率分别是68.1%和90.2%(P=0.010),5年无瘤生存率分别是66.1%和87.2%(P=0.013),5年无远处转移生存率分别是76.7%和93.6%(P=0.032),5年无局部复发生存率分别是84.9%和93.1%,P=0.220。Cox模型多因素分析显示,咽旁是否侵犯并不是独立预后因素,然而根据程度分级后的咽旁侵犯是影响预后的独立因素。4种咽旁划分同时纳入Cox多因素分析显示,闵氏划分的咽旁侵犯是影响总生存的独立预后因素(HR:2.231;P=0.001),Sham氏划分的咽旁侵犯是影响无瘤生存(HR:1.487;P=0.010)和远处转移(HR:1.246;P=0.009)的独立预后因素。结论:严重的咽旁侵犯是影响鼻咽癌总生存、无瘤生存和远处转移的独立预后因素,闵氏和Sham氏划分的咽旁侵犯对预后的影响最明显。OBJECTIVE：To evaluate the prognostic significance of the various classifications for parapharyngeal space（PPS） involvement in patients with nasopharyngeal carcinoma（NPC）.METHODS： From Jan 2000 to Jul 2000,a total of 176 patients with pathologically diagnosed NPC were prospectively enrolled in this study.The extent of PPS involvement examined by contrast-enhanced computed tomography scan was graded according to the four previously reported classifications（Min＇s,Sham＇s,Xiao＇s and Heng＇s）.RESULTS： The incidence of PPS involvement was 81.8%（144/176）.The 5-year overall survival（OS）,disease-free survival（DFS）,distant metastasis-free survival（DMFS）,and local relapse-free survival rates（LRFS） of the patients with and without PPS involvement were 68.1% and 90.2%（P=0.010）,66.1% and 87.2%（P=0.013）,76.7% and 93.6%（P=0.032）,84.9% and 93.1%（P=0.220）,respectively.Multivariate analysis showed that PPS involvement was not an independent prognostic factor.However,graded PPS involvement was an independent factor affecting the prognosis of NPC.When the four classifications were included in Cox model,it showed that PPS involvement based on Min＇s classification was an independent factor for OS（HR： 2.231;P=0.001）.PPS involvement based on Sham＇s classification was an independent factor for DFS（HR： 1.487;P=0.010） and DMFS（HR： 1.246;P=0.009）.CONCLUSIONS： Advanced PPS involvement shows stronger prognostic value than PPS involvement.The classification of PPS involvement proposed by Min＇s or Sham＇s is the most appropriate classification for parapharyngeal extension in NPC.

关 键 词：鼻咽肿瘤 放射疗法 咽旁间隙受侵 预后 

分 类 号：R739.63[医药卫生—肿瘤]