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目的通过对大宗鼻咽癌病例的临床分期因素分析,探讨随着影像学、放疗技术的进展及综合治疗策略的改进,鼻咽癌分期因素预测预后变化情况的意义。方法回顾性分析无远处转移初治鼻咽癌患者749例,根据’92分期标准,以疾病相关死亡、局部复发及远处转移等作为观察指标,对性别、年龄、T、N分期等因素作单因素和多因素分析。结果Ⅰ、Ⅱ、Ⅲ、Ⅳ期的病例数分别占4．0％、29．8％、33．6％和32．6％,各临床分期疾病相关生存曲线能较好地分开。单因素分析显示,所有与T和N分期有关的因素均有统计学意义;多因素分析显示,疾病相关死亡的独立预后因素有性别、年龄、口咽侵犯、副鼻窦侵犯、咽旁间隙受侵、颅神经受损、颅内侵犯及颈部淋巴结转移的部位、侧数等。局部复发的独立预后因素包括副鼻窦受侵、颅底骨质破坏、咽旁间隙受侵和颅内侵犯等。远处转移的独立预后因素包括咽旁间隙受侵、颅内侵犯、颈部淋巴结转移的部位、侧数等。结论’92分期标准基本能区分不同预后的患者,各临床分期的病例数分布较为合理,鼻咽癌分期因素的预后分析结果可为各种临床研究设计提供依据。T分期中可将各种颅神经受损情况归为同一期,使分期简单化。N分期中则应考虑颈部转移淋巴结单双侧的信息。
Objective To analyze the clinical stage factors of large nasopharyngeal carcinoma (NPC) cases and to explore the significance of predicting the prognosis of nasopharyngeal carcinoma with the progress of imaging and radiotherapy and the improvement of comprehensive treatment strategies. Methods A total of 749 nasopharyngeal carcinoma patients without distant metastasis were retrospectively analyzed. According to the ’92 staging criteria, the factors such as gender, age, T, N stage and other factors were analyzed with disease-related death, local recurrence and distant metastasis as observation indexes As a single factor and multivariate analysis. Results The number of cases of stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 4.0%, 29.8%, 33.6% and 32.6% respectively, and the disease-related survival curves of various clinical stages were well separated. Univariate analysis showed that all the factors related to T and N staging were statistically significant. Multivariate analysis showed that the independent prognostic factors of disease-related death were gender, age, oropharyngeal invasion, paranasal sinuses invasion, parapharyngeal space clearance , Cranial nerve damage, intracranial invasion and neck lymph node metastasis, lateral number and so on. The independent prognostic factors of local recurrence include paranasal sinuses invasion, skull base bone destruction, parapharyngeal space invasion and intracranial invasion. The independent prognostic factors of distant metastasis included parapharyngeal space invasion, intracranial invasion, site of cervical lymph node metastasis, lateral number and so on. Conclusion ’92 staging criteria can basically distinguish patients with different prognosis, the distribution of the number of cases in each clinical stage is more reasonable, prognostic analysis of staging factors of nasopharyngeal carcinoma can provide the basis for a variety of clinical research design. T staging in a variety of cranial nerve damage can be classified as the same period, to simplify the staging. N staging should consider single and bilateral cervical lymph node metastasis information.