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本文按照1422例鼻咽癌放射治疗后随访5年的结果,将T和N有关因素与5年生存率和远转移率分别作比较后提出:一、原发灶(T)分期按局限鼻咽(T1)、邻近超腔T2和远隔超越腔(T3)分为三个档次;二、转移淋巴结(N)分期应按所在颈区、长径大小及其活动度综合考虑,分为N0、N1、N2、N3四个档次,其中长径以≤5cm和≥8cm划分。单或双侧颈淋巴结转移的预后无明显差异;三、T、N、M组合方面,因N3的5年生存率仅6.25％～19.05％,T3尚有33.33％,建议T3为Ⅲ期,N3为Ⅳa为宜;远转移(M1)的预后极差,应和晚期的T或N有所区别而划为Ⅳb。本文对影响分期的各因素进行了讨论,对长沙分期、AJCC和Ho方案作了比较,显示本方案更能反映分期在指导制订治疗方案和评估预后的作用。
In this paper, according to the results of follow-up of 5 years after radiotherapy of 1,422 nasopharyngeal carcinomas, the relevant factors of T and N are compared with the 5-year survival rate and distant metastasis rate. Then, the following points are presented: First, the primary tumor (T) staging is limited to the nasopharyngeal (T1), adjacent hypercavity T2 and distant transcendence cavities (T3) are divided into three grades; Second, the metastasis of lymph node (N) staging should be based on the neck area, the size of the long diameter and its activity, and divided into N0, N1, N2, N3 four grades, in which the long diameter is divided by ≤ 5cm and ≥ 8cm. There was no significant difference in the prognosis of single or bilateral cervical lymph node metastases. 3. In the combination of T, N, and M, the 5-year survival rate of N3 was only 6.25% to 19.05%, and T3 was 33.33%. It is recommended that T3 be phase III, N3 It is appropriate for IVa; the prognosis of distant metastasis (M1) is extremely poor and should be differentiated from late T or N and classified as IVb. This article discusses the factors affecting the staging, and compares the stages of Changsha, AJCC and Ho, showing that the program can better reflect the role of staging in the development of treatment plans and the evaluation of prognosis.