1016例鼻咽癌远处转移患者的转移分层细化及其临床意义  

Evaluation of the prognostic significance of refinement and stratification of distant metastasis status in 1016 cases of nasopharyngeal carcinoma

作　　者：潘长穿[1] 卢进[1] 陈萍[1] 李晓[1] 金永东[1] 赵明[2] 夏云飞[3] 吴沛宏[2] 

机构地区：[1]四川省肿瘤医院肿瘤内科,成都市610041 [2]中山大学肿瘤防治中心影像与微创治疗科 [3]中山大学肿瘤防治中心影像与放疗科

出　　处：《中华肿瘤杂志》2013年第8期595-599,共5页Chinese Journal of Oncology

基　　金：四川省卫生厅科研课题（120029）

摘　　要：目的 探讨临床转移特征对转移性鼻咽癌的预后影响，为鼻咽癌远处转移（M1期）的多层次分期细化提供帮助。方法1016例鼻咽癌远处转移患者根据转移时序性（同时性和异时性）、转移器官类别（肺、骨、肝）、转移器官数目（单个、多发）和转移灶数目（孤立、多发）进行分组，分析其生存情况。结果全组鼻咽癌最常见的远处转移部位分别为骨（542例，53．3％）、肺（420例，41．3％）、肝（302例，29．7％）。孤立性转移164例。同时性转移376例，异时性转移640例。全组鼻咽癌远处转移患者的转移后中位生存时间为30．8个月，其中同时性转移和异时性转移患者的转移后中位生存时间分别为23．3个月和36．7个月。同时性转移的鼻咽癌患者1、3、5年生存率分别为74．2％、27．6％和18．5％，异时性转移的鼻咽癌患者1、3、5年生存率分别为88．1％、49．6％和28．6％，差异均有统计学意义（均P〈0．001）。多因素分析结果显示，转移灶数目、转移器官类别和初诊时N分期是影响鼻咽癌异时性远处转移患者预后的独立因素（均P〈0．05）。结论针对鼻咽癌远处转移的不同情况，建立鼻咽癌远处转移多层次分期的理论，根据其预期生存时间选择合适的个体化治疗方案，提高鼻咽痛的诊治水平。Objective To investigate the prognostic factors for nasopharyngeal carcinoma （NPC） with different metastatic status, and to improve the NPC management by multi-level refinement and stratification of M1 stage distant metastases. Methods Clinicopathological data of 1016 NPC patients with distant metastases were retrospectively reviewed. The M1 stage distant metastases were subdivided into synchronous or metachronous metastases, metastatic sites （lung, bone, liver）, number of metastatic organs （solitary, multiple） and number of metastases （solitary, multiple） subgroups to analyze the prognosis and survival of the patients. Results The most frequently involved metastatic sites were bone （542, 53.3% ）, lung （420, 41.3% ） and liver （302, 29.7% ）. There were solitary metastatic lesions in 164 patients （ 16.2% ） , synchronous metastases in 376 cases and metachronous metastases in 640 cases. The median overall survival of the whole group of 1016 NPC patients was 30.8 months since the time of diagnosis of metastasis. For the 376 patients in the synchronous metastasis group, the median survival was 23.3 months and the 1-, 3- and 5-year overall survival rates were 74.2% , 27.6% and 18.5%, respectively. For the 640 patients in the metachronous metastases group, the median survival was 36.7 months, and the 1 -, 3- and 5- year overall survival rates were 88.1%, 49.6% and 28.6%, respectively, with a significant difference between the two groups （ all P 〈 O. 001 ）. Cox multivariate analysis indicated that the number of metastatic lesions, different metastatic sites and N stage at initial diagnosis were independent prognostic factors for patients with metachronous metastases （ P 〈 0.05 ）. Conclusions A theory of detailed multi-level metastasis （ M1 ） stratification aiming at different distant metastasis status for nasopharyngeal carcinoma is proposed. To take appropriate individualized treatment scheme according to the prognosis and expected survival should be helpful to improving th

关 键 词：鼻咽肿瘤 肿瘤转移 预后 肿瘤治疗方案 

分 类 号：R739.63[医药卫生—肿瘤]