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目的分析鼻咽癌颅神经受累情况及其与预后的关系,并进一步探讨鼻咽癌颅神经受累对临床治疗的意义。方法回顾性分析935例首程治疗的鼻咽癌患者,以初次就诊时的症状和临床查体有无颅神经受累将患者分为颅神经受累组和未受累组。分析颅神经受累对预后的影响。结果全组颅神经受累率为20．0%,以第5对颅神经受累最常见。颅神经受累组与未受累组5年局部复发率分别为20．1%和16．8%(P=0．465)。在颅神经受累患者中,颅底照射剂量＜70、70～79、≥80 Gy组5年局部复发率分别为38．1%、24．5%和16．0%(P=0．082)。颅神经受累组与未受累组5年远处转移率分别为31．6%和19．5%(P=0．020),5年总生存率分别为62．2%和78．1%(P=0．000),无瘤生存率分别为43．2%和62．4%(P=0．000)。多因素分析显示颅神经受累是影响总生存率和无瘤生存率的独立预后因素,其相对危险度分别为1．62(95%CI=1．11～2．53,P=0．001)和1．40(95% CI=1．05～1．88,P=0．020)。结论鼻咽癌颅神经受累者5年远处转移率显著增加,并导致5年总生存率和无瘤生存率显著降低。适当提高局部剂量有望提高局部控制率。放化结合的综合治疗可能对这部分患者有应用价值。
Objective To analyze the relationship between cranial nerve involvement and prognosis of nasopharyngeal carcinoma (NPC) and to explore the clinical significance of cranial nerve involvement in NPC. Methods A retrospective analysis of 935 cases of nasopharyngeal carcinoma patients treated with first-line treatment was performed. The patients were divided into cranial nerve involvement group and non-involvement group according to the symptoms of the first visit and the presence or absence of cranial nerve involvement in the clinical examination. Analysis of cranial nerve involvement on prognosis. Results The cranial nerve involvement rate of the whole group was 20.0%. The fifth cranial nerve involvement was the most common. The 5-year local recurrence rates in cranial nerve involvement group and non-involvement group were 20.1% and 16.8%, respectively (P = 0.465). In patients with cranial nerve involvement, the 5-year local recurrence rates at cranial base irradiation <70,70 to 79 and ≥80 Gy were 38.1%, 24.5% and 16.0%, respectively (P = 0.082) . The 5-year distant metastases in cranial nerve involvement group and non-involvement group were 31.6% and 19.5%, respectively (P = 0.020). The 5-year overall survival rates were 62.2% and 78.1% P = 0.000). The tumor-free survival rates were 43.2% and 62.4% (P = 0.000), respectively. Multivariate analysis showed that cranial nerve involvement was an independent prognostic factor affecting overall survival and disease-free survival, with relative risk of 1.62 (95% CI = 1.11-2.53, P = 0.001) And 1.40 (95% CI = 1.05-1.88, P = 0.020). CONCLUSIONS: The 5-year distant metastasis rate of cranial nerve involvement in nasopharyngeal carcinoma is significantly increased, leading to a significant reduction of 5-year overall survival and tumor-free survival rate. Appropriate to increase the local dose is expected to increase the local control rate. Radiotherapy combination therapy may have value in this part of the patient.