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【目的】探讨基于磁共振成像(MRI)的鼻咽癌颅底骨质破坏的预后价值。【方法】于2003年至2004年共924例经病理等确诊为无远处转移的鼻咽初治病人纳入本研究,所有的病人均在治疗前进行了MRI检查并以放疗为首要治疗手段。我们回顾性的分析了相应的MRI及病历资料。所有的924例病人、MRI证实有颅底骨质破坏的病人、315例T3分期的的病人及227例T2分期的病人被分别挑选出来进行预后分析。分期依据美国癌症分期联合委员会(AJCC)第六版鼻咽癌分期标准。【结果】MRI下颅底骨质破坏的发生率约为55.4%。颅底骨质破坏并非影响鼻咽癌患者总生存(OS)和无远处转移生存(DMFS)的独立预后因素,但有可能是影响无局部复发生存(LRFS)的独立预后因素(P=0.068)。对于512例合并颅底骨质破坏的患者及315例T3分期的患者,根据受侵部位进行的颅底骨质破坏分级是影响其OS(P=0.002及P=0.005)及DMFS(P值均为0.001)的独立预后因素。MRI下严重级别的颅底骨质破坏是影响鼻咽癌患者OS及DMFS的独立预后因素(P值均小于0.001)。合并轻度级别颅底骨质破坏的T3分期患者与T2a分期的患者在预后方面(OS、LRFS及DMFS)的差异没有统计学意义。【结论】MRI下的颅底骨质破坏并非鼻咽癌患者的独立预后因素;然而,根据受侵部位的严重级别的颅底骨质破坏具有阳性的预后价值。
【Objective】 To investigate the prognostic value of magnetic resonance imaging (MRI) for the destruction of skull basement of nasopharyngeal carcinoma. 【Methods】 From 2003 to 2004, a total of 924 nasopharyngeal primary patients diagnosed as distant metastasis by pathology were enrolled in this study. All patients underwent MRI examination and radiotherapy as the primary treatment . We retrospectively analyzed the corresponding MRI and medical records. All 924 patients with MRI-confirmed bone loss in the skull base, 315 patients with T3 staging, and 227 patients with T2 staging were individually selected for prognostic analysis. Staging is based on the American Association for Cancer Staging (AJCC) Sixth Edition of the Nasopharyngeal Cancer Staging Criteria. 【Results】 The incidence of skull base fracture under MRI was 55.4%. Skull base bone destruction is not an independent prognostic factor affecting overall survival (OS) and distant metastasis-free survival (DMFS) in patients with nasopharyngeal carcinoma, but may be an independent prognostic factor that affects LRFS (P = 0.068 ). For 512 patients with cranial bone destruction and 315 patients with T3 staging, the skull basement bone destruction classification according to the affected site affected OS (P = 0.002 and P = 0.005) and DMFS (P = 0.001) independent prognostic factors. The severity of skull base bone destruction under MRI was an independent prognostic factor for both OS and DMFS in patients with nasopharyngeal carcinoma (P values <0.001). There were no significant differences in prognosis (OS, LRFS and DMFS) between T3 staging patients with mild grade cranial base bone destruction and T2a staging. 【Conclusion】 The skull basement bone destruction under MRI is not an independent prognostic factor for nasopharyngeal carcinoma. However, the prognostic value of skull base bone destruction according to the severity of the affected site has a positive prognostic value.