鼻咽癌眼眶转移临床分析

目的分析、总结11例鼻咽癌（NPC）眼眶转移患者的临床特点和预后。方法回顾性分析1991至2003年间在中山大学中山眼科中心进行诊治的11例NPC眼眶转移患者的一般情况、临床表现、影像学检查、病理检查、治疗及随访情况。结果11例患者中男性9例,女性2例;平均年龄45．5岁;发生左眼眶转移10例,右眼眶转移1例。有明确NPC病史7例,无NPC病史4例;自NPC确诊至出现眼部症状平均12．7个月（2．0～60．0个月）;就诊时眼部症状平均持续10．3个月（0．7～36．0个月）。眼眶有1处转移灶9例,2处转移灶2例;肿物主体位于眶鼻侧8例,颞侧2例,眶尖处1例,位于眶前部8例。手术将肿物全部取出或部分切除并送病理检查,结果提示鳞癌4例,淋巴上皮癌2例,未分化型5例。5例患者死于NPC远处转移,自确诊NPC眼眶转移至死亡间隔时间平均21个月;1例死因及存活时间不明;3例仍存活,未发现活动性病灶并继续接受治疗;2例失访。结论NPC眼眶转移临床很少见,但于中山眼科中心就诊的眼眶转移癌患者中原发于NPC者所占比例最高。转移病灶多数位于眼眶前部及鼻侧。患者预后较差。

Clinical analysis of orbital metastasis from nasopharyngeal carcinoma

Objective Metastasis of nasopharyngeal carcinoma(NPC) to the orbit has been rarely known.We report 11 patients with metastasis of NPC to the orbit and discuss their clinical characteristics and prognosis.Methods Eleven patients with orbital metastasis of NPC who were seen between January 1,1991 and December 31,2003 in Zhongshan Ophthalmic Center,Sun Yat-sen University,were retrospectively reviewed.Results Among 11 patients,there were nine males and two females.The mean age at diagnosis was 45.5 years.The left eye was involved in ten cases,and right eye in one.There were seven patients with a known history of NPC and four with no NPC history at the time of presentation.The seven patients with NPC history developed orbital metastasis at a mean time of 12.7 months(range 2.0-60.0 months) after the diagnosis of NPC.The mean duration of eye lesions at presentation was 10.3 months(range 0.7-36.0 months).Nine patients developed single metastatic focus and two patients had two foci in the affected orbit.The main component of the tumor was located in the nasal part of the orbit in eight cases,in the temporal part in two,and in the orbital apex in one.The anterior part of the orbit was affected in eight cases.The neoplasm was resected completely or partly through surgery.The diagnosis was histopathologically confirmed as NPC.Among them,four cases were squamous cell carcinomas,two cases lymphoepitheliomas,and five cases unclassified carcinomas.At the last following up examination,five patients had died as a result of disseminated metastasis,one patient had died of unknown cause and three were still alive with no active metastasis.Two patients had lost follow-up.The mean survival time after orbital diagnosis was 21 months.Conclusions NPC with orbital metastasis is rare.However,it is the most common primary cancer metastasizing to the orbit in our Center.Most of them were located in the anterior nasal part of the orbit.The prognosis of these metastasis cases is very poor.