Ⅲ期、ⅣA期鼻咽癌患者椎前肌及颅底枕骨侵犯的预后分析  

Prognostic value of prevertebral muscle and clivus involvement in patients with stageⅢand stageⅣA nasopharyngeal carcinoma

作　　者：梁久平 覃雪玲[1] 鲍俊初 黄英荷 杜绪仓 李恒国 LIANG Jiuping;QIN Xueling;BAO Junchu;HUANG Yinghe;DU Xucang;LI Hengguo(Department of Radiology,Shenzhen Songgang People's Hospital,Shenzhen 510105,China)

机构地区：[1]深圳市松岗人民医院放射科,广东深圳510105 [2]深圳市宝安区人民医院放射科,510101 [3]暨南大学附属第一医院影像中心,510630

出　　处：《临床肿瘤学杂志》2022年第7期600-607,共8页Chinese Clinical Oncology

基　　金：深圳市宝安区科技计划资助项目(2020JD461)。

摘　　要：目的探讨鼻咽癌椎前肌及颅底枕骨侵犯对Ⅲ期和ⅣA期鼻咽癌患者预后的影响。方法收集2010年12月至2017年12月新发Ⅲ期和ⅣA期鼻咽癌患者141例,分为鼻咽癌椎前肌侵犯组89例,鼻咽癌不伴椎前肌侵犯组52例,鼻咽癌椎前肌侵犯但不伴颅底骨质侵犯组36例,鼻咽癌颅底枕骨侵犯组55例(53例合并椎前肌侵犯)。计算各组病例的1、3、5年局部无复发生存率、无远处转移生存率和生存率。影响预后的多因素分析采用Cox比例风险回归模型。结果Cox多因素分析显示,性别、椎前肌侵犯、V区淋巴结转移和淋巴结最大径是影响鼻咽癌患者无远处转移生存时间的独立因素(P<0.05);而各纳入因素均与局部无复发生存时间和总生存时间无关(P>0.05)。鼻咽癌不伴椎前肌侵犯组与鼻咽癌椎前肌侵犯组1、3、5年局部无复发生存率分别为100.0%、98.0%、98.0%和98.0%、91.0%、86.0%(P=0.071);1、3、5年无远处转移生存率分别为100.0%、98.0%、91.0%和91.0%、81.0%、77.0%(P=0.008),1、3、5年生存率分别为100.0%、98.0%、98.0%和100.0%、86.0%、84.0%(P=0.024)。鼻咽癌椎前肌侵犯但不伴颅底骨质侵犯组与鼻咽癌颅底枕骨侵犯组1、3、5年局部无复发生存率分别为97.0%、91.0%、91.0%和96.0%、92.0%、83.0%(P=0.674),1、3、5年无远处转移生存率分别为97.0%、79.0%、79.0%和96.0%、83.0%、76.0%(P=0.807),1、3、5年生存率分别为98.0%、78.0%、78.0%和100.0%、93.0%、90.0%(P=0.169)。结论鼻咽癌椎前肌侵犯是影响患者无远处转移生存时间的独立因素。椎前肌侵犯与颅底枕骨侵犯患者的生存数据相似,在鼻咽癌T分期中二者受侵为相同分期更为合适。Objective To investigate the prognostic value of prevertebral muscle and clivus involvement in stageⅢand stageⅣA nasopharyngeal carcinoma patients.Methods From December 2010 to December 2017,141 patients with stageⅢand stageⅣA nasopharyngeal carcinoma were collected and divided into nasopharyngeal carcinoma with prevertebral muscle invasion group(n=89)and nasopharyngeal carcinoma without prevertebral muscle invasion group(n=52),nasopharyngeal carcinoma with prevertebral muscle invasion without skull base bone invasion(n=36)and nasopharyngeal carcinoma with skull base and occipital bone invasion(n=55,53 cases with prevertebral muscle invasion).The 1-,3-and 5-year local recurrence-free survival rate,distant metastasis-free survival rate and overall survival rate of each group were calculated.Cox proportional hazard regression model was used in the multivariate analysis of prognosis.Results Cox multivariate analysis showed that gender,prevertebral muscle invasion,cervical V-region lymph node metastasis and the maximum diameter of metastatic lymph nodes were independent factors affecting distant metastasis-free survival of nasopharyngeal carcinoma patients(P<0.05);All the included factors were not related to local recurrence-free survival and overall survival(P>0.05).The 1-,3-,and 5-year local recurrence-free survival rates of nasopharyngeal carcinoma without prevertebral muscle invasion group and nasopharyngeal carcinoma with prevertebral muscle invasion group were 100.0%,98.0%,98.0%and 98.0%,91.0%,86.0%,respectively(P=0.071);The 1-3-and 5-year distant metastasis-free survival rates were 100.0%,98.0%,91.0%and 91.0%,81.0%and 77.0%respectively(P=0.008),and the 1-,3-and 5-year survival rates were 100.0%,98.0%,98.0%and 100.0%,86.0%and 84.0%respectively(P=0.024).The 1-,3-,and 5-year local recurrence-free survival rates were 97.0%,91.0%,91.0%and 96.0%,92.0%,83.0%(P=0.674)in the nasopharyngeal carcinoma group with prevertebral muscle invasion without skull base bone invasion and the nasopharyngeal carcinoma group w

关 键 词：鼻咽癌 椎前肌 颅底枕骨 预后 

分 类 号：R739.63[医药卫生—肿瘤]