406例鼻咽癌患者颈部及Ⅴ区后缘间隙淋巴结转移的预后分析  

Prognosis of cervical and posterior to level Ⅴ lymph node metastasis in 406 cases of nasopharyngeal carcinoma

作　　者：蒋朝阳[1] 张涛[1] 高辉[1] 张伶[1] 

机构地区：[1]成都军区总医院放疗科,成都市610083

出　　处：《中国肿瘤临床》2017年第20期1019-1023,共5页Chinese Journal of Clinical Oncology

摘　　要：目的:回顾性分析鼻咽癌患者伴有颈部及Ⅴ区后缘间隙淋巴结转移的预后情况,为颈部淋巴结分区及鼻咽癌N分期的进一步修订提供参考。方法:选取2011年12月至2016年6月成都军区总医院经病理确诊为鼻咽癌的患者406例,分析伴有颈部及Ⅴ区后缘间隙淋巴结转移患者的预后情况。结果:406例患者的5年总生存率(overall survival,OS)、无进展生存率(progressionfree survival,PFS)、无局部复发生存率(local relapse-free survival,LRFS)、无远处转移生存率(distant metastasis-free survival,DMFS)分别是75.0%、63.4%、87.2%和81.8%。伴有Ⅴ区后缘间隙淋巴结转移患者的3年OS、PFS、LRFS、DMFS分别是51.5%、22.7%、90.0%和41.3%。N3期患者伴或不伴有Ⅴ区后缘间隙淋巴结转移的3年OS、PFS、LRFS、DMFS分别是43.9%和84.7%(P=0.002)、12.9%和55.4%(P=0.006)、88.9%和80.3%(P=0.649)、33.0%和85.9%(P<0.001)。单因素分析显示N分期是影响OS、PFS、DMFS的预后因素(P<0.05),多因素分析显示Ⅴ区后缘间隙淋巴结转移是影响DMFS的独立预后因素(P<0.05)。结论:鼻咽癌患者伴有Ⅴ区后缘间隙淋巴结转移预后差,且该区淋巴结转移预示患者远处转移的风险增加。建议将Ⅴ区后缘间隙作为头颈部肿瘤一个新的颈部分区。Objective： To investigate the prognosis of cervical and posterior to level V（PLV） lymph node metastasis and discuss further updates on neck levels and N stages for nasopharyngeal carcinoma（NPC）. Methods： A total of 406 pathologically diagnosed NPC cases from December 2011 to June 2016 were retrospectively analyzed. SPSS 20.0 was used to analyze the prognosis of patients with cervical and PLV lymph node metastasis. Results： In the 406 cases, the 5-year overall survival（OS）, progression-free survival（PFS）, local relapse-free survival（LRFS）, and distant metastasis-free survival（DMFS） were 75.0%, 63.4%, 87.2%, and 81.8%, respectively. The 3-year OS, PFS, LRFS, and DMFS of patients with node involvement of PLV were 51.5%, 22.7%, 90.0%, and 41.3%, respectively. For the N3 stage, the 3-year OS, PFS, LRFS, and DMFS with or without PLV involvement were 43.9% and 84.7%（P=0.002）, 12.9% and 55.4%（P=0.006）, 88.9% and 80.3%（P=0.649）, and 33.0% and 85.9%（P〈0.001）, respectively. Univariate analysis showed that N stage was a prognostic factor for OS, PFS, and DMFS（P〈0.05）. Multivariate analysis demonstrated that PLV was an independent prognostic factor for DMFS（P〈0.05）. Conclusion： Patients with NPC with PLV node involvement exhibited poor prognosis and an increased risk of distant metastasis. Thus, PLV should be a new neck node level for head and neck tumors.

关 键 词：鼻咽癌 淋巴结转移 Ⅴ区后缘 预后 放射治疗 

分 类 号：R730.55[医药卫生—肿瘤] R739.63[医药卫生—临床医学]