鼻咽癌原发灶复发患者53例临床分析  

Clinical analysis of 53 patients with local recurrence of nasopharyngeal carcinoma

作　　者：李冰[1] 司勇锋[1] 覃扬达[1] 翁敬锦[1] 兰桂萍[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,南宁市530021

出　　处：《广西医学》2017年第4期453-456,共4页Guangxi Medical Journal

基　　金：广西科学研究与技术开发计划(桂科攻1355005-3-9;桂科攻14124003-3)

摘　　要：目的总结分析复发鼻咽癌的临床特征。方法收集53例复发鼻咽癌患者的病例资料,对复发就诊时的临床表现、影像学显示肿瘤侵犯部位、病理特点及临床再分期等特征进行分析。结果 53例原发灶复发的鼻咽癌患者的中位年龄是49岁,中位复发时间27个月。复发时间<2年者20例占37.74%,2~5年者28例占52.83%,>5年者5例占9.43%。不同复发时间者原发时N分期比较,差异有统计学意义(P<0.05)。局部复发伴随有N1+N2颈部淋巴结转移患者的构成比明显低于原发时(P<0.05),而局部复发不伴随有颈部淋巴结转移(N0)患者的构成比明显高于原发时(P<0.05)。治疗后≤5年复发的患者首诊时多为Ⅲ+Ⅳ期及T3+T4期;而>5年复发的患者首诊时多为Ⅰ+Ⅱ期及T1+T2期,且多无颈部淋巴结转移。复发鼻咽癌最常见的侵犯部位是鼻咽腔28.30%(15/53),其次是茎突前间隙及颅底,均为15.09%(8/53)。结论鼻咽癌治疗后的1.5年及5.5年为复发高峰期,复发者病变部位多较原发者侵犯范围更广,多伴有颅底骨质破坏和(或)颅内侵犯。Objective To summarize and analyze the clinical characteristics of recurrent nasopharyngeal carcinoma （rNPC）. Methods Clinical data of 53 patients with rNPC were collected for an analysis on the characteristics of patients＇ clinical manifestations at relapse,tumor invasion revealed by imaging,pathological features and clinical re-staging. Results The median age of 53 patients with local rNPC was 49 years and the median relapse time was 27 months. There were 20 cases （ 37.74% ） whose relapse time less than 2 years, 28 （52.83%） more than 2 years and less than 5 years, and 5 （9.43%） more than 5 years. There was statistically significant difference in the N staging among patients with different relapse times（P 〈0.05 ）. Local recurrent patients with N1 ＋ N2 cervical lymph node metastasis had significantly lower proportion compared to primary patients（P 〈0.05） ,while local recurrent patients without cervical lymph node metastasis（NO） had significantly higher proportion compared to primary patients （P 〈 0. 05 ）. After treatment,most of patients with relapse time less than or equal to 5 years were in the stage m ＋IV or stage T3 ＋T4 in the initial visit,while most of patients with relapse time more than 5 years were in the stage I ＋11 or stage T1 ＋T2 in the initial visit,and no cervical lymph node metastasis was observed. The most common site of rNPC invasion was nasopharyngeal cavity （28.30%, 15/53 ）, followed by the pre-process of styloid and skull base （ both 15.09%, 8/53 ）. Conclusion The relapse peak of nasopharyngeal carcinoma occurs at 1.5 and 5.5 years after treatment. The recurrent patients mostly have more extensive invasion zone of diseased region compared to the primary patients, accompanied by skull base destruction and/or intracranial invasion.

关 键 词：鼻咽肿瘤 复发 原发灶 临床特征 TNM分期 

分 类 号：R766.3[医药卫生—耳鼻咽喉科]