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目的探讨鼻咽癌肝转移的临床特点、化疗效果及预后因素。方法采用SPSS13.0统计软件回顾性分析100例鼻咽癌肝转移化疗患者的临床资料、生存及预后因素。结果全组肝转移后中位化疗3.5程(1～14程),其中35例化疗>4程。一线化疗予PF方案和非PF方案分别为71例和29例,有效率分别为57.7%和42.9%,差异无统计学意义(P=0.137)。全组肝转移中位间期(DFS)9个月(0～119个月),肝转移后的中位生存期9个月(1～45个月),1、2、3年生存率分别为32.0%、11.0%、2.0%;化疗程数>4与≤4程患者组的中位生存期分别为14个月与7个月,差异有统计学意义(P=0.001)。单因素分析示:化疗的程数、疗效达CR及是否肝脏放疗(P值分别为0.002、0.020及0.015)影响肝转移预后;多因素分析显示DFS、初治即转移、化疗的程数、疗效达CR及肝脏放疗为影响预后的重要因素。结论鼻咽癌肝转移预后不良,对于可耐受的患者应予多程全身化疗,争取疗效达CR,部分患者可尝试辅以肝脏姑息性放疗,可显著改善预后。
Objective To investigate the clinical features, chemotherapeutic effect and prognostic factors of hepatic metastasis of nasopharyngeal carcinoma. Methods The clinical data, survival and prognostic factors of 100 cases of NPC with liver metastasis and chemotherapy were retrospectively analyzed by using SPSS 13.0 statistical software. Results All the patients underwent liver metastases after median chemotherapy for 3.5 courses (range, 1 ~ 14 courses), including 35 cases of chemotherapy> 4 courses. The rates of first-line chemotherapy for PF and non-PF were 71 and 29, respectively, with efficiencies of 57.7% and 42.9%, respectively, with no significant difference (P = 0.137). The median time to liver metastases (DFS) was 9 months (range, 0-119 months), median survival after hepatic metastasis was 9 months (1-45 months), and 1, 2, The median survival time was 14.0 and 11.0% respectively. The median survival time was 14 and 7 months, respectively. The difference was statistically significant (P = 0.001). Univariate analysis showed that the number of chemotherapy, CR and whether liver radiotherapy (P values were 0.002,0.020 and 0.015, respectively) affect the prognosis of liver metastasis; multivariate analysis showed that the DFS, the initial treatment of transfer, the number of chemotherapy, efficacy CR and liver radiotherapy are important prognostic factors. Conclusions The prognosis of NPC with liver metastasis is poor. For tolerable patients, multiple courses of systemic chemotherapy should be performed to obtain CR, and some patients may try adjuvant with palliative radiotherapy of the liver to improve the prognosis.