鼻咽癌患者临床分期的相关因素分析

目的：探讨鼻咽癌患者的临床分期与临床特点及病理类型间的相关性。方法：回顾性分析2016年6月至2021年9月在宁波市鄞州区第二医院住院初次确诊的鼻咽癌患者63例（排除已行放化疗的鼻咽癌患者），分析其临床分期及性别、年龄、首诊症状、首诊时间、伴发症状、淋巴结转移、肿瘤生长方式、病理类型等特点。结果：63例鼻咽癌患者，其中男49例，女14例，年龄22～82（53.8±1.7）岁。I期、II期、III期、IV期分别为17例（占27.0%）、14例（占22.2%）、29例（占46.0%）和3例（占4.8%），早期31例，中晚期32例，早期诊断率49.2%。首诊症状按照出现率高低依次为上颈部淋巴结肿大24例（占38.1%）、涕血18例（占28.5%）、鼻塞10例（占15.9%）、耳鸣耳闷8例（占12.7%）、鼻出血和头痛及无症状各1例（均占1.6%）。早期患者首诊时间为（2.4±0.3）个月，中晚期患者首诊时间为（5.4±1.1）个月。有伴随症状的早、中晚期患者占比分别为15例（48.4%）、24例（75%）。经Logistic回归分析，首诊症状为淋巴结肿大或涕血、首诊时间越迟、有伴随症状和淋巴结转移是鼻咽癌患者中晚期临床分期的独立危险因素（P＜0.05）。结论：鼻咽癌临床分期与首诊症状、首诊时间、有无伴随症状和有无淋巴结转移相关。缩短首诊时间是发现早期鼻咽癌的重要手段，出现涕血、鼻塞、耳鸣耳闷、鼻出血或上颈部淋巴结肿大必须在2个月内做一次鼻咽部检查。

Analysis of related factors in clinical staging of nasopharyngeal carcinoma patients

Objective: To study the correlation between clinical stage and related factors of nasopharyngeal carcinoma patients, and to provide clinical data for early diagnosis and treatment of nasopharyngeal carcinoma. Methods: From June 2016 to September 2021, 63 patients with nasopharyngeal carcinoma hospitalized for initial diagnosis in the Second Hospital of Yinzhou District, Ningbo (Patients with nasopharyngeal carcinoma were excluded from radiotherapy and chemotherapy) were retrospectively analyzed, and their clinical stages, symptoms of first diagnosis, time of first diagnosis, concomitant symptoms, lymphatic metastasis, tumor growth pattern, pathological type and other characteristics were analyzed. Results: Of 63 patients with nasopharyngeal carcinoma, there were 49 males and 14 females (male: female=3.5:1), aged from 22 to 82 years, with an average of (53.8±1.7) years. There were 17 cases (27.0%) in stage I, 14 cases (22.2%) in stage II, 29 cases (46.0%) in stage III and 3 cases (4.8%) in stage IV, respectively. There were 31 cases in early stage and 32 cases in middle and late stage, with the early diagnosis rate being 49.2%. Symptoms at first diagnosis in the order of occurrence rate were upper neck lymph node enlargement in 24 cases (38.1%), bloodsucking nose in 18 cases (28.5%), nasal obstruction in 10 cases (15.9%), tinnitus in 8 cases (12.7%), nosebleed, headache and no symptoms in 1 case (1.6%) respectively. The time of first diagnosis was (2.4±0.3) months for early-stage patients and (5.4±1.1) months for middle and late stage patients. The proportion of patients with concomitant symptoms was 15/31 (48.4%) and 24/32 (75%), respectively. Logistic regression analysis showed that initial symptoms (lymphadenopathy, nasal blood aspiration), longer initial diagnosis time, concomitant symptoms, and lymph node metastasis were independent risk factors for middle and late clinical stages of nasopharyngeal carcinoma (P<0.05). Conclusion: The clinical stage of nasopharyngeal carcinoma was correlated with first diagnosis symptoms, time of first diagnosis, concomitant symptoms and lymph node metastasis. Shortening the time of first diagnosis is an important means to find early nasopharyngeal carcinoma. Nasopharyngeal examination must be done once within 2 months in cases of reflux, nasal obstruction, tinnitus and stuffy ears, nasal bleeding or lymph node enlargement in upper neck.