125例鼻咽癌患者治疗后发生远处转移的临床多因素分析

目的:探讨鼻咽癌患者治疗后发生远处转移的特点和临床影响因素,建立远处转移预测模型,为临床提供参考.方法:2001年5月-2006年5月收治鼻咽癌治疗后0.5年出现远处转移的患者125例,采用Cox回归模型分析远处转移的影响因素,并建立远处转移危险指数(HI)公式,并根据HI值将全部患者分为不同的危险组进行比较.结果:125例中骨转移60例(48.0%),肝转移43例(34.4%),肺转移42例(33.6%),多脏器、多部位转移28例(22.4%),0.5～2年发生远处转移89例(71.2%).单因素分析显示T分期、N分期、临床分期、颈淋巴结转移影响治疗后远处转移(P＜0.01).多因素分析显示N分期、临床分期、有无化疗是鼻咽癌治疗后远处转移的重要影响因素,不同危险组发生远处转移的危险差异有显著性(P＜0.01).结论:大部分鼻咽癌患者发生远处转移在治疗后2年内,常见转移部位是骨、肝、肺.HI值能较好地反映远处转移的危险性.

Clinical multivariable analysis of distant metastasis after treatment in 125 patients with nasopharyngeal carcinoma

Objective:To explore the rule and clinically influential factors of distant metastasis after treatment in patients with nasopharyngeal carcinoma (NPC), and to establish a predictive model of distant metastasis for physicians to formulate individualized treatment regimen. Methods:From May 2001 to May 2006, there were 125 patients with NPC admitted to the hospital, and they had distant metastasis discovered half a year after treatment,and their data were analyzed retrospectively. Clinically influential factors were analyzed and hazard index(HI) for distant metastasis was built using Cox regression model and calculated on basis of multivariable analysis. According to HI values, patients were categorized into 4 different risk groups and inter-group comparison was made with Log-rank methods.Results:Organs in which the distant metastasis easily occurred bone in cases (48.0%), liver in 43 cases(34.4%), lung in 42 cases (33.6%). In 28(22.4%) patients multi-organ metastasis was discovered at the same time. The distant metastasis occurred in 89 cases (71.2%) between half a year and two years after treatment. Single factors analysis showed that T stage, N stage, clinical stage,cervical lymph nodes metastasis were influential factors of distant metastasis after treatment(P<0.01).Multivariable factoranalysis revealed that N stage, clinical stage,or no chemotherapy were main influential factors of distant metastasis with patients of NPC after treatment. Difference in different risk groups was very significant(P<0.01). Conclusions: The distant metastasis of most NPC occurred within two years after treatment.Predominant organs for metastasis were bone, liver, lung. HI value will be very useful in predicting risk of distant metastasis in these patients.