颈部挽救性手术在NPC放疗后颈部淋巴结残留和复发中的应用价值及其影响因素  

The application value and prognostic factors of salvage surgery for neck recurrence or residue of nasppharyngeal carcinoma after primary radiotherapy

作　　者：朱小龙[1] 缪爱林[1] 周顶斌[1] 

机构地区：[1]江苏省常州市第四人民医院耳鼻咽喉头颈外科,江苏常州213000

出　　处：《临床和实验医学杂志》2015年第24期2060-2062,共3页Journal of Clinical and Experimental Medicine

摘　　要：目的探讨颈部挽救性手术在鼻咽癌(NPC)放疗后颈部淋巴结残留和复发中的应用价值及其影响因素。方法回顾性分析2001年1月至2012年12月行挽救性手术治疗的NPC放疗后颈部淋巴结残留或复发的98例患者的临床资料。总结分析总生存率及其相关临床影响因素。结果全组3年和5年累积生存率分别为55.2%和38.6%,中位生产时间46个月,Cox分析显示复发分期和淋巴结包膜外侵是影响颈部挽救性手术生存率的危险因素(RR=1.976,1.986,P<0.05),而放疗是其保护因素(RR=0.465,P<0.05)。结论 NPC放疗后淋巴结残留或复发采取挽救性手术安全有效,初始治疗方式、复发分期、淋巴结包膜外侵与生存预后相关。术式选择应该根据患者病情合理选择改良或者根治颈淋巴清扫术。Objective To investigate the surgical managements for residual or recurrent diseases in the neck after radiotherapy in nasopharyngeal carcinoma. Methods A total of 98 cases neck recurrence or residue after radiotherapy in NPC who received salvage neck surgery between January 2001 and December 2012 were retrospectively analyzed. Overall survival and the correlated clinical factors were analyzed. Results The3- year and 5- year over survival rates were 55. 2% and 38. 6%,respectively,and the median survival time was 46 months. Cox analysis showed that the recurrence of stage,lymph node extracapsular invasion were risk factors affecting survival（ RR = 1. 976,1. 986,P 〈 0. 05）,and radiation therapy was a protective factor（ RR = 0. 465,P 〈 0. 05）. Conclusion Salvage surgery was effective for neck recurrence or residue of NPC after primary treatment,and initial treatment,N stage and lymph node stage of extracapsular extension correlate with prognosis. The choice of operation should be according to the condition of patients.

关 键 词：鼻咽癌 颈淋巴结清扫术 放疗 颈淋巴结转移 

分 类 号：R739.63[医药卫生—肿瘤]