初治转移性鼻咽癌预后影响因素分析及治疗模式探讨  

Investigation of Prognostic Influencing Factors and Treatment Options in Treatment-naive Patients with Metastatic Nasopharyngeal Carcinoma

作　　者：陈雪 叶栋[2] 刘开泰[1] 贝宴屏 郑璐[1] CHEN Xue;YE Dong;LIU Kai-tai;BEI Yan-ping;ZHENG Lu(Department of Radiotherapy,Lihuili Hospital of Ningbo Medical Center,Ningbo 315000,China;Department of E.N.T.,Lihuili Hospital of Ningbo Medical Center,Ningbo 315000,China)

机构地区：[1]浙江省宁波市医疗中心李惠利医院放疗科,315000 [2]浙江省宁波市医疗中心李惠利医院耳鼻喉科,315000

出　　处：《中国全科医学》2018年第14期1682-1688,共7页Chinese General Practice

基　　金：宁波市自然科学基金资助项目(2013A610217)

摘　　要：目的探讨初治转移性鼻咽癌预后的影响因素,为临床制定治疗策略及预后的判断提供依据。方法选取2011年1月—2016年9月在宁波市医疗中心李惠利医院放疗科就诊的初治转移性鼻咽癌患者52例,对其进行化疗,记录其临床资料,并对患者进行随访,随访截至2017年3月,分析患者预后的影响因素。结果患者随访时间为4.4~79.8个月,中位随访时间为32.3个月,中位生存时间为29.4个月。患者2、3、5年总生存率分别为55.9%、45.8%、18.5%。不同性别、年龄、T分期、肺转移、远处淋巴结转移、转移灶数目、化疗周期、转移灶处理、血红蛋白、血清清蛋白、碱性磷酸酶、纤维蛋白原、血清清蛋白/碱性磷酸酶(AAPR)水平患者3年生存率比较,差异均无统计学意义(P>0.05);不同N分期、骨转移、肝转移、多器官转移、近期疗效、原发灶放疗、乳酸脱氢酶、D-二聚体水平患者3年生存率比较,差异均有统计学意义(P<0.05)。多因素Cox生存回归分析结果显示,N3期[HR=6.315,95%CI(2.004,19.904)]、合并肝转移[HR=5.810,95%CI(2.200,15.341)]、合并多器官转移[HR=3.770,95%CI(1.317,10.793)]、原发灶未行放疗[HR=5.537,95%CI(1.740,17.620)]、碱性磷酸酶≥100 U/L[HR=7.657,95%CI(2.313,25.344)]是初治转移性鼻咽癌不良预后的危险因素(P<0.05)。结论基于N分期、是否合并肝转移、是否多器官转移、原发灶是否接受放疗、碱性磷酸酶水平是初治转移性鼻咽癌患者预后的影响因素,并且有助于指导治疗方案的选择,进而提高总生存率。ObjectiveTo investigate factors affecting the prognosis of treatment-naive patients with metastatic nasopharyngeal carcinoma,to provide evidence for the development of treatment strategies and inform on the prognosis of treatment-naive metastatic nasopharyngeal carcinoma.MethodsA total of 52 treatment-naive patients with metastatic nasopharyngeal carcinoma admitted to the Department of Radiotherapy,Lihuili Hospital of Ningbo Medical Center between January 2011 and September 2016 were enrolled and given chemotherapy.The patients＇ clinical data were recorded,and the patients were followed up until March 2017.The factors affecting the prognosis of the patients were analyzed.ResultsPatients were followed up for a median of 32.3 months（range 4.4-79.8 months） and had a median survival period of 29.4 months.The 2-,3- and 5-year overall survival rates were 55.9%,45.8% and 18.5%,respectively.The 3-year overall survival rate did not significantly differ in terms of gender,age,pathologic T stage,lung metastasis,distal lymph node metastasis,number of metastatic foci,number of chemotherapy cycles,management of metastatic foci,hemoglobin level,albuminlevel,alkaline phosphatase level,fibrinogen concentration and albumin-to-alkaline phosphatase ratio（AAPR） level（P〉0.05）,and significantly differed in terms of pathologic N stage,bone metastasis,liver metastasis,multi-organ metastasis,short-term efficacy,radiotherapy of primary foci,lactate dehydrogenase level and D-dimer level（P〈0.05）.Multivariate Cox regressionanalysis identified N3 stage 〔HR=6.315,95%CI（2.004,19.904）〕,liver metastasis 〔HR= 5.810,95%CI（2.200,15.341）〕,multi-organ metastasis 〔HR=3.770,95%CI（1.317,10.793）〕,non-radiotherapy of primary foci〔HR=5.537,95%CI（1.740,17.620）〕 and serum alkaline phosphatase level of 100 U/L and higher 〔HR=7.657,95%CI（2.313,25.344）〕 as the risk factors for poor prognosis（P〈0.05）.ConclusionPathologic N stage,liver metastasis,multi-organ metastasis,radiotherapy of primary foci

关 键 词：鼻咽肿瘤 肿瘤转移 化放疗 预后 

分 类 号：R739.63[医药卫生—肿瘤]