纤维鼻咽镜下鼻咽癌调强放疗后残留病灶的病理证实及动态观察  

Pathological Confirmation and Observation of Residual Diseases in the Nasopharynx Based on Fiberoptic Endoscopic Examination after Intensity-modulated Radiotherapy for Nasopharyngeal Carcinoma

作　　者：汤轶强[1] 曾雷[1] 敖帆[1] 罗庆丰[1] 廖瑜露[1] 黄敏[1] 陈淑兰 李道进 李金高[1] TANG Yiqiang;ZENG Lei;AO Fan(Jiangxi Cancer Hospital,Nanchang,330029)

机构地区：[1]江西省肿瘤医院

出　　处：《实用癌症杂志》2019年第12期1944-1946,1950,共4页The Practical Journal of Cancer

基　　金：江西省卫计委课题(编号:20161107)

摘　　要：目的对鼻咽癌调强放疗后纤维鼻咽镜下残留病灶进行肉眼分型和病理验证,并动态观察探寻其演变规律。方法将调强放疗后纤维鼻咽镜下鼻咽可疑病灶分为新生物、黏膜粗糙和单纯隆起3个类型。动态观察放疗结束后1月、3月和6月仍存在的可疑病灶,进行直视下活检,行病理检查,将病理结果分为癌组织、异形褪变细胞和炎症坏死组织。结果对112例放疗后1月的可疑病灶进行活检,其中新生物53例、黏膜粗糙36例和单纯隆起型23例。仅以病理为癌组织为阳性,其阳性率分别为18.9%、16.7%和13.0%,差异无统计学意义(P=0.927);若将异形细胞也归为阳性统计,则其阳性率分别为58.5%、52.8%和47.8%,差异亦无统计学意义(P=0.672)。放疗结束3月时,仍有9例肉眼可疑病灶,其中新生物型8例(病理结果为异形细胞4例、炎症组织4例),单纯隆起型1例(病理结果为炎症组织)。放疗结束6月时,仅1例肉眼表现为新生物,病理结果为异形细胞,并最终进展为鼻咽复发。结论鼻咽癌调强放疗后的纤维镜下肉眼残留病灶约半数并非病理残留。不同肉眼残留类型的病理阳性率并无差异,临床上不能因为残留病灶不典型而忽视其残留的可能性。调强放疗后病理残留者大多自然消退,并不意味着肿瘤未控。Objective To classify residual diseases in the nasopharynx based on fiberoptic endoscope and compare with pathology results,and to explore the evolution law of residual diseases by observation after intensity-modulated radiotherapy(IMRT)for nasopharyngeal carcinoma.Methods Residual diseases in the nasopharynx after IMRT based on fiberoptic endoscope were classified as neoplasm,mucous membrane coarse and elevated mucosa.Patients with suspicious residual diseases underwent biopsies by 1,3 and 6 months after IMRT.Pathology results were classified as positive for malignancy,positive with radiation change in tumor cells and inflammation.Results 112 patients with suspicious residual diseases 1 month after the completion of IMRT received biopsies.The number of patients with neoplasm,mucous membrane coarse 36 cases and elevated mucosa was 23,respectively.If the residual diseases with pathological positive for malignancy were defined as positive,the positive rates were 18.9%,16.7%and 13.0%,respectively.These differences were not statistically significant(P=0.927).If the residual diseases with pathological positive for malignancy and positive with radiation change in tumor cells were defined as positive,the positive rates were 58.5%,52.8%and 47.8%,respectively.No significant differences were observed among the 3 groups(P=0.672).3 months after the completion of IMRT,there were still 9 cases of suspicious residual lesions,including 8 cases of neoplasm,4 cases with positive with radiation change in tumor cells,4 cases with inflammation,and 1 case of simple elevated mucosa with inflammation.6 months after the completion of IMRT,only 1 patient with neoplasm and confirmed positive with radiation change in tumor cells by histology,and relapsed after 1 year of the completion of IMRT.Conclusion Almost half of patients with the residual diseases in the nasopharynx based on fiberoptic endoscope after IMRT has no residual lesions confirmed by histology.The positive rates of pathology were not associated with residual diseases in the n

关 键 词：纤维鼻咽镜 鼻咽癌 调强放疗 残留 病理 

分 类 号：R739.63[医药卫生—肿瘤]