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目的:探讨鼻咽原发性腺癌的发病情况、临床规律及临床诊治、预后情况。方法:回顾性分析1995-05-2008-10在我院经过病理确诊和治疗的23例鼻咽腺癌的临床资料。普通型腺癌12例,涎腺型腺癌11例。17例单纯放疗,1例单纯手术治疗,3例术后辅助放疗,1例术后残留补救放疗,1例术前放疗。随访4～204个月(中位随访时间55个月),随访率100%,生存期计算自病理确诊日开始至死亡或随访截止日。利用SPSS16.0软件包进行统计学分析,局控率、生存率分析采用Kap-lan-Meier法计算,颈淋巴结转移相关因素分析采用四格表的确切概率法。结果:本组病例占我院同期鼻咽癌病例总数的0.37%。发病年龄32～62岁,男女比例2.3∶1。颈部淋巴结转移率35%。5和10年局控率分别为64.8%和15.2%;5和10年生存率分别为78.2%和29.3%,病理类型、分化程度与淋巴结转移密切相关,差异具有统计学意义。结论:鼻咽腺癌临床表现与鼻咽癌类似,淋巴结转移主要与病理类型、分化程度有关;涎腺型、低度恶性普通型腺癌淋巴结转移少见,而高度恶性普通型腺癌淋巴结转移率高。虽放疗为主治疗可以取得较好生存率,治疗上应进一步探讨根据具体病理类型采取以手术为主或放疗为主的综合治疗。
Objective: To investigate the incidence of nasopharyngeal adenocarcinoma, clinical rules and clinical diagnosis and treatment, prognosis. Methods: The clinical data of 23 cases of nasopharyngeal adenocarcinoma confirmed by pathology and treated in our hospital from May 1995 to October 2008 were retrospectively analyzed. 12 cases of common type adenocarcinoma, 11 cases of salivary gland type adenocarcinoma. 17 cases of simple radiotherapy, 1 case of simple surgery, 3 cases of postoperative adjuvant radiotherapy, 1 case of residual salvage radiotherapy, 1 case of preoperative radiotherapy. The follow-up ranged from 4 to 204 months (median follow-up time was 55 months). The follow-up rate was 100%. The survival period was calculated from the date of diagnosis to death or the follow-up deadline. SPSS16.0 software package was used for statistical analysis. The local control rate and survival rate were calculated by Kaplan-Meier method. The exact probability method was used to analyze the related factors of cervical lymph node metastasis. Results: This group of patients accounted for 0.37% of the total number of NPC cases in our hospital over the same period. Age 32 to 62 years old, male to female ratio of 2.3: 1. Cervical lymph node metastasis rate of 35%. The 5-year and 10-year local control rates were 64.8% and 15.2% respectively. The 5-year and 10-year survival rates were 78.2% and 29.3% respectively. The pathological types and differentiation were closely related to lymph node metastasis. The difference was statistically significant. Conclusion: The clinical manifestations of nasopharyngeal adenocarcinoma are similar to those of nasopharyngeal carcinoma. Lymph node metastasis is mainly related to pathological type and differentiation degree. Lymphatic metastasis of salivary gland type and low grade common type adenocarcinoma is rare, while lymph node metastasis rate of high grade common type adenocarcinoma high. Although radiotherapy-based treatment can achieve better survival rate, the treatment should be further explored based on the specific pathological type of surgery-based or radiotherapy-based comprehensive treatment.