鼻咽癌伴脑神经损伤与预后关系的探讨

目的：探讨鼻咽癌脑神经损伤的特点及其与预后的关系。方法：收集2002-01—2003—12中山大学肿瘤防治中心经病理确诊的初治无远处转移鼻咽癌患者共1892例，分析脑神经损伤的情况和对预后的影响。结果：全组脑神经损伤率为9．4％，5年总生存率为61．0％，5年无瘤生存率为55．3％，5年局部区域无进展生存率为75．2％，5年无远处转移生存率为73．4％。单因素分析显示治疗前脑神经损伤症状期长短、治疗后3个月内脑神经损伤恢复程度、92分期、颈部淋巴结大小、海绵窦侵犯与否与预后相关。多因素分析显示，治疗后3个月内脑神经损伤恢复程度是影响5年总生存率的独立预后因素，其相对危险度为2．087。颈部淋巴结最大径超过20mm和海绵窦侵犯是影响5年无远处转移生存率的独立预后因素，其相对危险度分别为1．954和2．136。结论：鼻咽癌治疗前脑神经损伤症状期长短、治疗后脑神经损伤功能恢复程度与预后显著相关，海绵窦侵犯是远处转移的独立预后不良因素。

Relationship between cranial nerve involvement in nasopharyngeal carcinoma and the prognosis

Objective:To analyze the feature of cranial nerve involvement in nasopharyngeal carcinoma (NPC) and its relationship with the prognosis.Method:A total of 1892 patients who were diagnosed as NPC in our hospital from January 2002 to December 2003,of which the cranial nerve involvement was 183 (9.6%) patients, were analyzed the effect of cranial nerve involvement on the prognosis.Result:The percentage of cranial nerve involvement was 9.4%. The 5 year overall survival rate was 61.0%,disease free survival rate was 55.3%,local relapse free survival rate was 75.2% and distant metastasis free survival rate was73.4%.Periods of cranial nerve involvement,clinical stage,the diameter of the lymph nodes,involvement of cavernous sinus, and the level of the recovery of cranial nerve involvement were significantly associated with prognosis in univariate analysis(P<0.05).With multivariate analysis,the recovery level of cranial nerve involvement was the independent factor that affected the 5-year overall survival (RR=2.087). The diameter of the lymph nodes and involvement of cavernous sinus were the independent factors that affected the 5-year distant metastasis-free survival(RR=1.954 and 2.136,respectively).Conclusion:Periods of cranial nerve involvement and the level of the recovery of cranial nerve involvement were significantly correlated with prognosis. Involvement of cavernous sinus could increase the rate of distant metastasis.