基于MRI的鼻咽癌临床分期探讨

目的]探讨鼻咽癌92福州分期与UICC分期的合理性，提出鼻咽癌TNM分期修订新的设想。方法]72例初治鼻咽癌患者放疗前均接受MRI检查，基本检查序列包括T1WI轴位，T2WI抑脂轴位及T1WI或T2WI冠状位，其中25例行增强扫描。结果]92福州分期：Ⅱ期7例，Ⅲ期23例，Ⅳa期42例；T分期：T1I例，T2 9例，T3 21例，T4 41例；N分期：N0 3例，N1 48例，N2 18例，M3 3例。UICC分期：Ⅱ期2例，Ⅲ期28例，Ⅳa期39例，Ⅳb期3例；T分期：T1 1例，T2a 7例，T2b 2例，T3 21例，T4 41例；N分期：N0 3例，N1 8例，N2 58例，N3 3例。92福州分期Ⅲ～Ⅳ期病例占所有病例的90.3％：UICC分期Ⅲ～Ⅳ期病例占所有病例的97．2％。两种分期在临床分期和T分期中有较好的对应，无显著性差异，而在N分期具有显著性差异。结论]由于MRI对软组织极高的分辨能力，以致现有的分期方法使临床病例过于集中Ⅲ～Ⅳ期，鼻咽癌TNM分期需要修订以适应学科发展。

Discussion on Nasopharyngeal Carcinoma Staging Systems Based on Magnet Resonance Image (MRI)

Purpose] To investigate the rationality of UICC 2002 and 92＇Fuzhou staging systems on nasopharyngeal carcinoma, and to propose some new suggestion on revising staging systems. Methods] Seventy-two newly patients with nasopharyngeal carcinoma underwent MRI examination before radiotherapy, including T1-weighted axial series, T2-weighted fat suppressed axial series, T1-weighted and T2-weighted coronal series. And 25 of them received contrast-enhanced MRI examination. Results] According 92＇Fuzhou staging system, 7 patients were in stage Ⅱ; 23, stageⅢ; 42,Ⅳa.1 ,T1; 9, T2; 21, T3; and 41 ,T4. While 3patients had no lymphatic disease （NO）, 48 , N1; 18, N2; and 3, N3. Based on UICC 2002 staging system, 2 ,stage Ⅱ; 28, stage Ⅲ; 39 ,stage Ⅳa and 3 ,ivb. And 1, T1; 7, T2a; 2,T2b; 21, T3 and 41, T4, while 3, NO; 8, N1; 58, N2 and 3, N3. Stage Ⅲ and Ⅳ patients accounted for 90.3% based on the 92＇Fuzhou system, while the percentage was 97.2% if the UICC 2002 system was adopted. There was a good accordance of the distribution of clinical stage and T stage between the two systems, except of N stage which had a significant difference. Conclusion] The majority of patients are concentrated in stage Ⅲ and Ⅳ with the present staging systems, because MRI have a extremely high resolution capability on soft tissue. Staging systems of nasopharyngeal carcinoma should be revised to meet scientific development.