基于MRI的淋巴结包膜侵犯与鼻咽癌3DRT的预后关系  

Prognostic value of extracapsular spread of regional lymph nodes in nasopharyngeal carcinoma with 3DCRT based on magnetic resonance imaging

作　　者：张相国[1] 梁思贤 潘素明[1] 徐晓南[1] 程英[2] 黄菊红[1] 王教成[1] 马红霞[1] 

机构地区：[1]汕头大学医学院附属粤北人民医院放疗科,韶关512026 [2]汕头大学医学院附属粤北人民医院影像科,韶关512026

出　　处：《中华放射肿瘤学杂志》2017年第6期621-626,共6页Chinese Journal of Radiation Oncology

基　　金：广东省医学科研基金项目（A2012687）;韶关市卫生计生科研项目（Y16014）;韶关市科技计划项目（2016ws003）

摘　　要：目的 探讨基于MRI的鼻咽癌患者区域淋巴结包膜侵犯的临床特征与鼻咽癌3DRT的预后关系。方法 收集2009年—2013年间本院477例采用3DRT初治鼻咽癌患者资料,分析患者区域淋巴结包膜侵犯的临床特征及预后关系。结果 区域淋巴结包膜侵犯组216例,无包膜侵犯组261例。有包膜侵犯和无包膜侵犯组的中位生存期分别为38.5个月和39.0个月,3年OS、PFS、LRFS、DMFS分别为81.9%、65.8%、87.8%、80.3%和90.7%、85.0%、95.8%、92.9%（P=0.000）。单因素分析结果显示N分期及淋巴结包膜侵犯是影响鼻咽癌患者OS、PFS、LRFS及DMFS的重要影响因素（P=0.000~0.004）,而T分期、TNM分期与鼻咽癌患者OS、PFS、DMFS相关（P均=0.000）。Cox模型多因素分析显示T分期是影响鼻咽癌患者生存的预测因子,淋巴结包膜侵犯是影响鼻咽癌患者PFS、LRFS、DMFS因素。结论 淋巴结包膜侵犯患者容易出现局部复发或远处转移,是鼻咽癌患者重要预后因素。Objective To evaluate the prognostic value of the extracapsular spread （ECS） of regional lymph nodes in nasopharyngeal carcinoma （NPC） based on magnetic resonance imaging. MethodsA retrospective review was performed for 477 previously untreated patients with NPC who were treated in Yuebei People′s Hospital from January 2009 to December 2013.Univariate and multivariate survival analyses were performed to identify the prognostic value of ECS in NPC. Results There were 216 patients with ECS and 261 patients without ECS, and the median survival of the two groups of patients was 38.5 months and 39.0 months, respectively. The 3-year overall survival （OS）, progression-free survival （PFS）, local recurrence-free survival （LRFS）, and distant metastasis-free survival （DMFS） rates of the patients with ECS versus those without ECS were 81.9% versus 90.7%, 65.8% versus 85.0%, 87.8% versus 95.8%, and 80.3% versus 92.9%, respectively （all P=0.000）.The univariate analysis showed that N stage and ECS were important prognostic factors for OS, PFS, LRFS, and DMFS in NPC patients （P=0.000-0.004）, and T stage and TNM stage were associated with OS, PFS, and DMFS （all P=0.000）.The multivariate analysis using the Cox regression model showed that T stage was an independent prognostic factor for the survival of NPC patients, and ECS was an important prognostic factor for PFS, LRFS, and DMFS. Conclusion ECS of regional lymph nodes is a risk factor for local recurrence or distant metastasis in patients with NPC.

关 键 词：鼻咽肿瘤/三维放射疗法 肿瘤转移 淋巴结 预后 

分 类 号：R739.63[医药卫生—肿瘤]