椎前间隙侵犯对鼻咽癌预后影响的回顾性分析  

Prognostic impact of prevertebral space involvement in nasopharyngeal carcinoma

作　　者：周媛媛[1] 张思杏[1] 罗展雄[1] 李旌[1] 于斌[1] 李中华[1] 贺婵娟[1] 王磊黎[1] 石丰榕[1] ZHOU Yuanyuan;ZHANG Sixing;LUO Zhanxiong;LI Jing;YU Bin;LI Zhonghua;HE Chanjuan;WANG Leili;SHI Fengrong(Department of Radiotherapy,Liuzhou General Hospital,Liuzhou,Guangxi Zhuang Autonomous Region 545006,China)

机构地区：[1]柳州市人民医院肿瘤放疗科

出　　处：《安徽医药》2020年第1期103-106,I0002,共5页Anhui Medical and Pharmaceutical Journal

基　　金：广西壮族自治区卫生和计划生育委员会自筹经费科研课题（Z20170707)

摘　　要：目的探讨椎前间隙侵犯(prevertebral space involvement,PVSI)对鼻咽癌预后的影响。方法回顾性分析柳州市人民医院2009年7月至2015年12月经病理证实的初治并排除远处转移的250例鼻咽癌病人。所有病人放疗前行鼻咽部及颈部MRI检查,接受二维、三维适形或调强适形放疗联合或不联合化疗。Kaplan⁃Meier法计算生存率并经Log⁃rank检验,采用Cox多因素分析比较预后。结果中位随访时间56个月。共87例病人椎前间隙受侵(34.8%),为椎前间隙受侵组,另外163例为椎前间隙未受侵组。椎前间隙受侵组较未受侵组的T分期、N分期及临床分期明显较差(均P<0.001)。椎前间隙受侵组与未受侵组相比,总生存率(OS)、无局部区域复发生存(LRFS)、无远处转移生存(DMFS)分别为83.4%比64.4%(P<0.001)、90.8%比85.1%(P=0.069)、87.7%比71.3%(P<0.001)。Cox多因素分析结果提示,PVSI是影响两组病人OS(P=0.013)的因素和DMFS(P<0.001)的独立预后因素。结论鼻咽癌椎前间隙受侵发生率较高,且较未受侵者的OS、DMFS低,PVSI是影响鼻咽癌病人预后因素。Objective To evaluate the prognostic impact of prevertebral space involvement(PVSI)in nasopharyngeal carcinoma(NPC)which treated with radiotherapy and chemotherapy.Methods A retrospective analysis was performed on the clinical data of 250 patients who had newly diagnosed pathology proven as NPC without distant metastasis in Liuzhou General Hospital from 2009 July to December 2015.All patients underwent MRI scans of the nasopharynx and neck and were treated with two⁃dimensional radio⁃therapy or three⁃dimensional radiotherapy(3DCRT)or intensity modulated radiotherapy(IMRT)with or without chemotherapy.The Kaplan⁃Meier method was used to calculate the overall survival(OS),the locoregional relapse⁃free survival(LRFS)and the distant metastasis⁃free survival(DMFS),and the log⁃rank test was used for survival difference analysis.The Cox proportional hazards regres⁃sion analysis was used to assess the prognostic value of PVSI.Results The median follow⁃up time was 56 months.PVSI was seen in 92(34.8%)of these patients.The patients with PVSI had significantly higher T stage(P<0.001),N stage(P<0.001)and clinical stage(P<0.001)than those without PVSI.The OS,LRFS and DMFS for NPC patients with and without PVSI were 83.4%vs.64.4%(P<0.001),90.8%vs.85.1%(P=0.069),87.7%vs.71.3%(P<0.001),respectively.Cox multivariate analysis showed that PVSI was the prognosis factor for OS(P=0.013)and DMFS(P<0.001).Conclusion PVSI is common in NPC.The OS and DMFS for the patients with PVSI is significantly lower than those without PVSI.Moreover,PVSI is the prognostic factor in NPC patients.

关 键 词：鼻咽肿瘤 肿瘤转移 肿瘤浸润 预后 存活率分析 椎前间隙侵犯 

分 类 号：R73[医药卫生—肿瘤]