鼻咽癌放疗后颈部淋巴结复发rN3的治疗与预后因素分析  

Analyses of therapeutic and prognostic factors for rN3 neck recurrence of nasopharyngeal carcinoma after primary radiotherapy

作　　者：司勇锋[1] 翁敬锦[1] 邓卓霞 兰桂萍[1] 覃扬达[1] 张政[1] 王勇利[1] 陆锦龙[1] 江河[1] 孙金杰[1] 

机构地区：[1]广西壮族自治区人民医院耳鼻咽喉头颈肿瘤科,南宁530021

出　　处：《中华耳鼻咽喉头颈外科杂志》2015年第10期810-813,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：广西科学研究与技术开发计划项目科技攻关计划（桂科攻0816004-10）

摘　　要：目的探讨鼻咽癌放疗后颈部淋巴结复发rN3患者的治疗方式和预后影响因素。方法回顾性分析2003年10月至2013年8月因鼻咽癌放疗后颈部淋巴结复发且分期为rN3的37例患者的临床资料。其中有19例为锁骨上窝淋巴结转移，18例患者转移淋巴结直径〉6cm。有10例选择放疗联合化疗；9例行改良性颈淋巴清扫术，18例行根治性颈淋巴清扫术，其中6例行胸大肌皮瓣修复，术后有12例患者接受放疗，20例患者接受化疗。结果本组患者治疗后残留和复发8例，远处转移17例，复发并转移1例。全组5年总生存率和无瘤生存率分别为27．5％和21．6％，中位生存期41个月。5年总生存率手术联合放化疗组优于放化疗组；转移淋巴结直径〉6cm其预后优于锁骨上窝淋巴结转移组。结论复发鼻咽癌rN3患者较容易发生远处转移，其中锁骨上窝淋巴结转移者预后差。对于无远处转移的rN3患者．手术联合放化疗旱一种右妁的治疗手殷．Objective To investigate the treatment and prognosis for rN3 neck recurrence of nasopharyngeal carcinoma（NPC） after primary radiotherapy. Methods A total of 37 cases with rN3 neck recurrence after radiotherapy in NPC between October 2003 and August 2013 were retrospectively analyzed. Of them 19 cases presented with lymph node （LN） metastasis in supraclavicular fossa, 18 cases had metastasis LN 〉 6cm, 10 cases received chemoradiotherapy, and 27 cases underwent neck dissection including modified radical neck dissection （MRND） for 9 cases, radical neck dissection （RND） for 18 cases. Six of 18 cases with RND underwent reconstructive surgery with pectoralis major flap, 12 cases received postoperative radiotherapy and 20 cases had postoperative adjuvant chemotherapy. Results Eight patients had documented recurrence or residue, 17 patients developed distant metastases, one patient showed recurrence and distant metastasis. The 5 - year overall survival rate and disease - free survival rate were 27. 5% and 21.6% respectively, and the median survival time was 41 months. The survival rate in surgery group was significantly higher than that in chemoradiotherapy group, and the prognosis of patients with LN 〉 6cm was better than that of patients with metastasis LN to supraclavicular fossa. Conclusions Patients with rN3 NPC are prone to metastasis, and patients with supraclavicular fossa lymph node metastasis had poor prognosis. Surgery combined with chemoradiotberapy is an effective treatment for the patients without distant metastasis.

关 键 词：鼻咽肿瘤 肿瘤复发 局部 颈淋巴结清扫术 化放疗 

分 类 号：R739.63[医药卫生—肿瘤]