鼻咽癌放射治疗分型的临床研究

目的通过调查我院单纯根治性放射治疗的鼻咽癌患者,根据放射治疗后复发转移的情况,提出鼻咽癌临床放射治疗分型,总结其分布规律。方法随机抽取20世纪90年代在中山大学肿瘤防治中心行单纯根治性放疗鼻咽癌住院病人842例,根据5年的随访结果,无原发部位和区域淋巴结复发及无远处转移设定为辐射敏感不易转移型（Ⅰ型）、有原发部位或区域淋巴结复发及无远处转移定为辐射抗拒不易转移型（Ⅱ型）、无原发部位和区域淋巴结复发及有远处转移定为辐射敏感易转移型（Ⅲ型）、有原发部位或区域淋巴结复发及有远处转移定为辐射抗拒易转移犁（Ⅳ型）,分析4种临床放射治疗分型的分布规律以及4种分型与谢志光分型之间的联系。结果（1）4种分型的比例为辐射敏感不易转移型50．6％（426例）,辐射抗拒不易转移型23．2％（195例）,辐射敏感易转移型20．7％（174例）和辐射抗拒易转移型5．6％（47例）。（2）842例患者中有264例可按谢氏分型标准进行分型,其中上行型24．6％（65例）,下行型23．1％（61例）,混合型52．3％（138例）;上行型中：Ⅰ型58．5％,Ⅱ型29．2％,Ⅲ型10．8％,Ⅳ型1．5％;下行型中：Ⅰ型47．5％,Ⅱ型9．8％,Ⅲ型36．1％,Ⅳ型6．6％;混合型中：Ⅰ型34．8％,Ⅱ型26．8,Ⅲ型33．3％,Ⅳ型5．1％。（3）92临床分期早期（Ⅰ、Ⅱ期）有307例,Ⅰ型62．2％（191例）,Ⅱ型21．2％（65例）,Ⅲ型12．4％（38例）,Ⅳ型4．2％（13例）;晚期（Ⅲ、Ⅳ期）有535例,Ⅰ型43．9％（235例）,Ⅱ型24．3％（130例）,Ⅲ型25．4％（136例）,Ⅳ型6．4％（34例）。结论在鼻咽癌中存在上述4种放射治疗分型,其构成比为：放射敏感不易转移型（Ⅰ型）〉放射抗拒不易转移型（Ⅱ型）〉放射敏感易转移型（Ⅲ型）〉放射抗拒易转移型（Ⅳ型）,在谢氏的下行型和混合型中及92福州临床分期晚期（Ⅲ、Ⅳ期）中,放射敏感易转移型（Ⅲ型）的比例大于放射抗拒不易转移型（Ⅱ型）,放射治疗分型是对鼻咽癌临床分型及分期的补充。

Clinical study on radiotherapy-related typing of nasopharyngeal carcinoma

OBJECTIVE: To advance a new system of clinico-radiotherapeutic typing of nasopharyngeal carcinoma (NPC) and compare it with the typing system of Xie Zhiguang. METHODS: 842 patients with NPC, 559 males and 283 females, aged 48 (15-76), that had undergone CT and were treated with radical radiotherapy alone as the first therapeutic measure at least 5 years ago, were followed up for 5 years. Their cancers were divided into 4 types according to whether recurrence occurred in the primary focus and/or regional lymph nodes and whether distant metastasis occurred. The cancers without recurrence in the primary foci and regional lymph nodes and without distant metastasis was defined as radiosensitive and not liable to metastasize type (type I), those with recurrence in the primary foci and/or regional lymph noses but without distant metastasis were defined as radio-resistant and not liable to metastasize type (type II), those without recurrence in the primary foci and/or regional lymph nodes but with distant metastasis were defined as radiosensitive and liable to metastasize type (type III), and those with recurrence in the primary foci and/or regional lymph nodes and distant metastasis as well were defined as radio-resistant and liable to metastasize type (type IV). The distribution of these four clinico-radiotherapeutic types and the relation between them and the Xie Zhi-guang types: ascending type (type A), descending type (type D), and ascending and descending type (type AD). RESULTS: (1) The percentages of the Types I, II, III, and IV were 50.6% (426 cases), 23.2% (195 cases), 20.7% (174 cases), and 5.6% (47 cases) respectively. (2) 264 of the 842 patients could be typed according to Xie Zhi-guang typing criteria: 65 were defined as type A (24.6%), 61 (23.1%) as type D and 138 (52.3%) as type AD. Among the 65 patients of type A 58.5% were of type I, 29.2% were of type II, 10.8% were of type III, and 1.5% were of type IV; among the type D patients 47.5% were of type I, II 9.8% were of type, 36.1% were of type III, and 6.6% were of type IV; and among the type AD patients 34.8% were of type I, 26.8% were of type II, 33.3% were of type III, and 5.1% were of type IV. (3) 307 patients were at the early stage of Fuzhou clinical classification 1992 (stages I and II) among which 191 were of type I (62.2%), and 65 were of type II (21.2%), 38 were of the type III (12.4%), and 13 were of the type IV (4.2%). Among the 535 patients at the late stage (stages III and IV), 235 were of the type I (43.9%), 130 of the type II (24.3%), 136 were of the type III (25.4%), and 34 were of the type IV (6.4%). CONCLUSION: There are four radiotherapy-related types in NPC with the constituent ratio as: radiosensitive and not liable to metastasize type (type I) > radio-resistant and not liable to metastasize type (type II) > radiosensitive and liable to metastasize type (type III) > radio-resistant and liable to metastasize type (type IV). Among the NPC patients of the type D and type AD according to the Xie Zhiguang classification and the NPC patients at the advanced stage (stages III and IV) of the Fuzhou staging system 1992, the proportion of radiosensitive and liable to metastasize type (type III) exceeds that of the radio-resistant and not liable to metastasize type (type II). The radiotherapy-related typing system is a supplement to the clinical typing and staging of NPC.