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背景与目的:“92分期系统临床应用15年来,鼻咽癌的诊断和治疗水平发生了明显的改变。本研究旨在通过对基于现代诊断和治疗模式下大宗病例的鼻咽癌进行分期因素的探讨,为”92分期的改进提供参考。方法:收集2003年1月至2004年12月间中山大学肿瘤防治中心放疗科收治、经病理证实、无远处转移的初诊鼻咽癌924例,所有病例治疗前均行鼻咽和颈部MRI检查。采用归纳法分析“92分期中T因素之间的相互关系。N分期因素的筛选采用Cox风险比例模型进行多因素分析。根据临床分期的原则,采用风险一致性、风险差异性、预后预测及分布均衡性等指标对分期进行评价。结果:”92-T分期因素中,颈椎前软组织、软腭、翼腭窝及眼眶受侵时,均100%合并其它同一期别或更高期别的T因素受侵,91.3%(282/309)颈动脉鞘区肿物占据合并其它T3因素受侵,85.3%(64/75)单组颅神经受侵合并其他T4因素受侵。T3颈动脉鞘区肿物占据组(HR=1.635,95%CI:0.987～2.764)与T2组(HR=1.524,95%CI:0.910～2.368)的局部复发风险比较接近;T3单一颅底骨质受侵组(HR=3.567,95%CI:1.398～11.278)、广泛颅底骨质受侵组(HR=3.891,95%CI:1.449～10.449)及T4单纯蝶窦受侵组(HR=3.613,95%CI:1.437～11.854)局部复发风险比较接近;T3单组颅神经受侵组(HR=5.849,95%CI:2.069～14.500)和T4除蝶窦外受侵组(HR=6.618,95%CI:2.499～17.525)局部复发风险比较接近。多因素分析结果显示,淋巴结转移的水平、侧数是影响鼻咽癌远处转移的独立预后因素。由此,依据分期标准简洁的要求,删除软腭、颈椎前软组织、翼腭窝及眼眶等因素。依据风险一致性原则,将咽旁间隙包括茎突前间隙及颈动脉鞘区侵犯定义为T2,颅底骨质包括翼突区侵犯定义为T3,蝶窦受侵定义为T3,颅神经侵犯定义为T4。依据多因素分析结果,N分期考虑淋巴结侧数及水平。结论:本研究推荐的、基于磁共振成像的T、N及总临床分期标准符合风险一致性、风险差异性、分布均衡性及预测价值等临床分期原则,建议临床使用。
BACKGROUND & OBJECTIVE: “Clinical Application of Staging System [92] Significant changes have been made in the diagnosis and treatment of nasopharyngeal carcinoma over the past 15 years.” The aim of this study was to assess the prognosis of patients with nasopharyngeal carcinoma based on modern diagnostic and therapeutic modalities, To provide a reference for the improvement of 92 staging. Methods: 924 newly diagnosed nasopharyngeal carcinomas were collected from Department of Radiation Oncology, Sun Yat-sen University Cancer Center, from January 2003 to December 2004. Nasopharyngeal and cervical MRI were performed in all cases before treatment an examination. Induction was used to analyze the relationship between T-factors in stage 92. Screening for stage N factors was performed using multivariate Cox proportional hazards model.According to the principle of clinical staging, risk consistency, risk difference, prognosis and Distribution, balance and other indicators of staging were evaluated.Results: "92-T staging factors, anterior cervical soft tissue, soft palate, pterygopalatine fossa and orbital invasion, were 100% of the same period or higher with other T factor invasion, 91.3% (282/309) of carotid sheath tumor involvement and other T3 factor invasion, 85.3% (64/75) of single cranial nerve invasion and other T4 factor invasion. The risk of local recurrence in T3 carotid sheath tumor area (HR = 1.635,95% CI: 0.987-2.764) was similar to T2 group (HR = 1.524,95% CI: 0.910-2.368) (HR = 3.567,95% CI: 1.398 ~ 11.278), extensive skull base invasion group (HR = 3.891,95% CI: 1.449-10.449) and T4 simple sphenoid sinus invasion group (HR = (HR = 5.849,95% CI: 2.069 ~ 14.500) and T4 except sphenoid sinus invasion group (HR = 6.618,95% CI: 1.437-11.854) , 95% CI: 2.499 ~ 17.525) The risk of local recurrence is relatively close. Multivariate analysis showed that the level of lymph node metastasis, lateral number is an independent prognostic factor of distant metastasis of nasopharyngeal carcinoma. Thus, according to the staging requirements of simple, delete soft palate, anterior cervical soft tissue, pterygopalatine fossa and orbit and other factors. According to the principle of risk consistency, the parapharyngeal space, including the anterior segment of the styloid process and carotid sheath sheath infiltration was defined as T2, the skull base bone including the wing area infringement defined as T3, the sphenoid sinus invasion defined as T3, the definition of cranial nerve invasion T4. According to the results of multivariate analysis, N staging considered the number and level of lymph nodes. CONCLUSIONS: The T, N and total clinical staging criteria based on magnetic resonance imaging recommended in this study are consistent with the clinical staging principles of risk coherence, risk variability, distributional equilibria and predictive value, suggesting clinical use.