鼻咽癌扩散类型与远处转移的相关性

目的:探讨鼻咽癌扩散类型与远处转移的相关性.方法:回顾性分析260例初治鼻咽癌患者的临床资料,其中发生远处转移(转移组)162例,放疗后≥5年无复发或远处转移(无瘤组)98例.结合治疗前CT或MRI,重新确定T、N分期,把所有患者分为局限型(T1～2N0～1)36例、上行型(T3～4N0～1)68例、下行型(T1～2N2～3)75例和混合型(T3～4N2～3)81例,对两组间差异进行比较分析.结果:转移组患者中,局限型和上行型仅占25.3%,下行型和混合型占74.7%,无瘤组则分别为64.3%和35.7%(均P<0.01).在原发灶为局限病变的患者中,N2～3患者占转移组的84.4%,无瘤组为33.3%,差异有统计学意义(P<0.01).原发灶严重扩散的患者(T3～4)中,无瘤组N0～1为60%,N2～3为40%,转移组则分别为31.6%和68.4%,两组差异有统计学意义(均P<0.01).结论:颈部淋巴结转移程度与鼻咽癌发生远处转移密切相关,原发灶的严重扩散也不可忽视;即使是局限性病变,一旦发生严重颈部转移,其远处转移危险性明显增加.     

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。     

鼻咽癌颅底骨破坏的临床研究

通过１００例首产程放疗前病理和ＣＴ扫描证实为鼻咽癌颅底骨破坏的病例临床分析，发现头痛和颅神经损害症状是鼻咽癌颅底骨破坏的主要临床特征。颅神经第Ⅴ、Ⅵ、Ⅶ对的损害占前三位。结果还提示颅底骨破坏发生时间绝大多数在头痛和颅神经损害症状出现后１－６个月内。ＣＴ扫描在显示颅底各部位以及副鼻窦、海绵窦和眼眶侵犯方面，较之Ｘ线颅底摄片更充分显示出期诊断的独特优势。还讨论了颅底骨破坏与咽旁侵犯和颈淋巴结转移的关系     

鼻咽癌颅底骨破坏的临床研究

通过１００例首程放疗前病理和ＣＴ扫描证实为鼻咽癌颅底骨破坏的病例临床分析，发现头痛和颅神经损害症状是鼻咽癌颅底骨破坏的主要临床特征。颅神经第Ｖ、ＶＩ、ＸＩＩ对的损害占前三位。结果还提示颅底骨破坏发生时间绝大多数在头痛和颅神经损害症状出现后１～６个月内。ＣＴ扫描在显示颅底各部位以及副鼻窦、海绵窦和眼眶侵犯方面，较之Ｘ线颅底摄片更充分显示出其诊断的独特优势。还讨论了颅底骨破坏与咽旁侵犯和颈淋巴结转移的关系问题。     

鼻咽癌放-化疗后出现脑神经迟发性损害2例

198 9～ 1 995年 ,我们进行了一项关于诱导性动脉灌注化疗与全身化疗在鼻咽癌 ( NPC)综合治疗中疗效比较的研究 ,在随访中 ,发现有 2例无瘤生存的患者出现脑神经的迟发性损害 ,现报告如下。1　病例报告例 1　女 ,43岁 ,因涕血、头痛伴右耳听力下降2个月于 1 989年 1 0月就诊。间接鼻咽镜检查见鼻咽右顶后壁菜花样新生物 ,累及右咽隐窝和咽鼓管圆枕。肿物活检证实为低分化鳞癌。CT扫描示右侧颅底破坏及右咽旁间隙占位性病变 ,但未触及颈淋巴结肿大 ,也无脑神经麻痹征象 ,确诊为 NPC,T4 NOMO,临床分期 期 (长沙分期 )。采用化 -放疗联…     

鼻咽癌死亡病例临床资料分析

目的 :研究鼻咽癌患者死亡因素。方法 :对 1974～ 1990年收治的 6 77例鼻咽癌死亡患者的临床资料进行系统分析。结果 :本组患者男女之比为 4 .3∶1,4 0～ 6 0岁年龄组最多 ,以低分化鳞癌为主 ,Ⅲ Ⅳ期病例占81.3% ;放疗与化疗联合治疗组存活时间较单纯放疗组长 ,5 4 .9%死于远处转移 ,2 0 .9%死于局部或区域淋巴结未控制。结论 :鼻咽癌主要死因为远处转移、局部或区域淋巴结未控制 ,化疗与放疗联合治疗有可能延长生存时间 ,降低死亡率     

鼻咽癌颅底骨质破坏放射治疗后预后因素分析

目的评价分析鼻咽癌颅底骨质破坏在首程放射治疗后远期疗效及预后因素.方法1985～1986年100例经病理证实为鼻咽癌,均为鳞状细胞癌,其中低分化96例,高分化4例.所有病例经CT扫描证实颅底骨质被破坏,胸部X线摄片及腹部B型超声检查未见异常.采用60Co或直加单纯外照射,总剂量66～80 Gy/6～8周,2 Gy/次.所有患者均定期随访,平均随访22.3个月(2～174个月).采用Kaplan-Meier统计生存率,Cox模型分析各种预后因素,包括侵犯海绵窦、蝶窦、筛窦、上颌窦,咽旁间隙侵犯、头痛、颅神经损害,治疗后头痛缓解及颅神经损害的修复等.结果 1、3、5、10年生存率分别为78.8%、38.0%、26.9%、13.0%,但伴有前组颅神经(Ⅰ～Ⅷ)和后组颅神经(Ⅸ～Ⅻ)同时侵犯者5年生存率仅为7.7%.死亡原因包括局部复发59例,远处转移21例,局部复发加远处转移1例,非肿瘤原因死亡5例.经多因素分析影响预后的独立因素为颅神经损害、放射治疗后颅神经修复及头痛缓解.结论鼻咽癌颅底骨质侵犯患者的长期随访结果分析,发现颅神经损害、放射治疗后颅神经修复及头痛症状的缓解对预后有重要意义.     

头颈部鳞状细胞癌远处转移的相关因素分析

目的探讨头颈肿瘤远处转移的相关影响因素.方法对532例头颈部原发鳞状细胞癌患者的临床病理资料进行回顾性分析.选择性别、年龄、临床分期、T分级、N分级、原发癌部位、原发癌浸润深度、原发癌病理分级、有无颈淋巴结转移、颈阳性淋巴结数目、颈淋巴结转移累及区域、颈阳性淋巴结破膜情况等临床病理因素,用χ2检验和Logistic回归进行单因素和多因素分析,并用Kaplan-Meier法对发生远隔部位转移患者进行生存分析.结果在532例头颈部原发鳞状细胞癌患者中,60例(11.3%)发生远处转移.单因素分析显示,临床分期(P=0.0126)、T分级(P=0.0082)、原发癌部位(P=0.0011)、原发癌浸润深度(P=0.0005)、有无颈淋巴结转移(P=0.0057)、颈阳性淋巴结数目(P=0.0149)、颈淋巴结转移累及区域(P=0.0034)、颈阳性淋巴结破膜情况(P=0.0118)与发生远处转移有关.多因素分析结果表明,仅原发癌部位、原发癌浸润深度与发生远处转移明显相关.用Kaplan-Meier法进行生存分析,结果显示60例发生远隔部位转移患者的1年生存率、3年生存率、5年生存率分别为51.7%、13.3%、6.5%.结论原发肿瘤部位和浸润深度是发生远处转移的共同决定性因素.而原发癌临床分期、T分级和有无颈淋巴结转移是头颈鳞癌远处转移的影响因素,但不是导致远处转移的初始和根本因素.喉癌、下咽癌以及原发癌侵犯肌肉、骨或软骨患者易发生远处转移.     

鼻咽癌颅底骨质破坏放射治疗后预后因素分析

目的 评价分析鼻咽癌颅底骨破坏在首程放射治疗后无期疗效及预后因素。方法 1985-1986年100例经病理证实为鼻咽癌,均为鳞状细胞癌,其中低分化96例,高分化4例。所有病例经CT扫描证实颅底骨质被破坏,胸部X线摄片及腹部B型超声检查未见异常。采用^60Co或直加单纯外照射,总剂量66-80Gy/6-8周,2Gy/次。所有患者均定期随访,平均随访22.3个月（2-174个月）。采用Kaplan-Meier统计生存率,Cox模型分析各种预后因素,包括侵犯海绵窦、蝶窦、筛窦、上颌窦,咽旁间隙侵犯、头痛、颅神经损害,治疗后头痛缓解入颅神经损害的修复等。结果 1、3、5、10年生存率分别为78.8%、38.0%、26.9%、13.0%,但伴有前组颅神经（Ⅰ-Ⅷ）和后级颅神经（Ⅸ-Ⅻ）同时侵犯者5年生存率仅为7.7%。死亡原因包抱局部复发59例,远处转移21例,局部复发加远处转移1例,非肿瘤原因死亡5例。经多因素分析：影响预后的独立因素为颅神经损害、放射治疗后颅神经修复及头痛缓解。结论 鼻咽癌颅底骨质侵犯患者的长期访结果分析,发现颅神经损害、放射治疗后颅神经修复及头痛缓解。结论 鼻咽癌颅底骨质侵犯患者的长期随访结果分析,发现颅神经损害、放射治疗后颅神经修复及头痛症状的缓解对预后有重要意义。     

鼻咽癌放射治疗失败后手术治疗的有关问题

目的：通过对本院1989－1992年鼻咽癌放射治疗失败后手术治疗23例的回顾性分析，探索其手术适应证，术式及禁忌证等有关问题。方法：对放疗后原发灶复发5例，颈淋巴结转移灶复发7例，放疗后转移5例，颅底侵犯4例，颞下窝侵犯2例的手术，阐明有关问题。结果：手术后3年、5年生存率分别为52％及35％，手术并发症发生率7％。结论：（1）鼻咽癌放疗失败后的手术治疗，术前必须明确病灶是未控，复发、转移或瘢痕增生；（2）手术应根据病灶部位及范围选择不同径路及方式进行；（3）对已有远处器官转移，颅底破坏侵及脑组织或恶病质患者不宜手术治疗。     

Meningiomas invading the temporal bone with extension to the neck

Meningiomas are the second largest group of brain tumors after gliomas. They account for 13 to 18 per cent of all primary intracranial neoplasms. The majority occur in the cerebral chamber; only 8 to 9 per cent are located in the cerebellar chamber. Meningiomas are hamartomatous, not truly neoplastic tumors, which arise from dural fibroblasts and particularly from arachnoid cells that tend to cluster around the tips of the arachnoid villi. Their preferential sites correspond closely with the locations where arachnoid villi are most frequently encountered, namely, along the major venous sinuses and their contributory veins, at the foramina of exit of the cranial nerves, and where arachnoid cell clusters are found within the trunk or the perineural sheaths of cranial nerves within or adjacent to the basal foramina. Of all intracranial meningiomas, 20 per cent eventually develop an extracranial extension. These extracranial extensions project, in order of decreasing frequency, to 1) the orbit, 2) the external table of the calvaria, 3) the nasal cavity and paranasal sinuses, and 4) the parapharyngeal (cervical) space. Once a meningioma has gained access to the temporal bone, its tendency to extend beyond the confinements of the skull increases to 43 per cent. The most frequent pathway is through the jugular and lacerate foramina into the parapharyngeal space, where it may manifest as a nasopharyngeal, oropharyngeal, retromaxillary, retromandibular, or cervical neck mass. A meningioma in the parapharyngeal area can represent 1) an extracranial extension of a primary intracranial tumor, 2) a neoplasm arising in the jugular foramen, 3) a neoplasm originating from an arachnoid cell cluster within the trunk of a cranial nerve or its perineural sheaths within or near a neural foramen, or 4) a metastasis to a cervical lymph node from a primary intracranial meningioma. Meningiomas extending to the neck are unique because of their tendency toward extracranial expansion, higher incidence of local recurrence, multicentric growth, and frequent combination with other neoplasms of the central nervous system. They are frequently an expression of the central form of neurofibromatosis (von Recklinghausen's disease).     

鼻咽癌放化疗局部失败的相关因素分析

目的：探讨鼻咽癌放化疗后局部失败（残留或复发）的相关影响因素。方法：对308例鼻咽部原发癌患者的临床病理资料进行回顾分析。选择性别、年龄、T分级、N分级、原发癌病理类型、有无颈淋巴结转移、颈转移淋巴结大小、颈淋巴结转移侧数、颈淋巴结转移累及区域、放疗方法、有无同步化疗等临床病理因素,用x^2检验和Logistic回归进行单因素和多因素分析,并用Kaplan-Meier法对残留和复发患者进行生存分析。结果：在308例头颈部原发鳞状细胞癌患者中,93例（30．2％）发生原发灶和颈部的残留或复发。单因素分析显示,T分级（P〈0.01）、N分级（P〈0.01）、有无颈淋巴结转移（P〈0.05）、颈转移淋巴结大小（P〈0.05）、颈淋巴结转移侧数（P〈0.01）与残留或复发有关。多因素分析结果表明,仅T分级与残留或复发明显相关。用Kaplan-Meier法进行生存分析显示71例残留或复发患者再次治疗的1年、3年、5年生存率分别为77．2％、40．4％、22．4％。结论：原发癌T分级是鼻咽癌治疗局部失败的决定性因素。而有无颈淋巴结转移、原发癌N分级、颈淋巴结转移侧数、颈淋巴结大小是影响因素和T分级的协同因素,但不是导致残留和复发的的初始和根本因素。鼻咽癌侵犯骨时易导致治疗失败。治疗失败者经再次治疗可以提高生存率。     

乙酰肝素酶、nm23-H1在鼻咽癌中的表达以及与侵袭转移的关系

目的 探讨乙酰肝素酶(HPA)和nm23-H1在鼻咽癌组织中的表达以及与肿瘤侵袭转移的关系。方法 用免疫组化技术检测HPA和nm23 H1在60例鼻咽癌组织和20例鼻咽慢性炎症组织中的表达情况,并结合患者的临床病理指标进行分析。结果 HPA在鼻咽慢性炎症组织和鼻咽癌组织中的阳性表达率分别为0（0/20）和55%（33/60）（P＜0.05）;nm23 H1在鼻咽慢性炎症组织和鼻咽癌组织中的阳性表达率分别为90.0%（18/20）和53.3%（32/60）（P＜0.05）。在鼻咽癌组织中,随着鼻咽癌临床分期和侵袭程度的升级,以及有颈淋巴结转移和远处转移时,HPA阳性表达逐渐增加,而nm23-H1阳性表达逐渐减少（P<0.05）;HPA和nm23-H1的表达呈明显负相关（P＜0.05）。结论 HPA的阳性表达和nm23-H1阴性表达的鼻咽癌患者有较高的侵袭转移潜能。     

Distant lymphatic metastasis from head and neck cancer.

A predictable pattern of metastasis based on tumor histology and site of origin has been well documented for most cancers that arise in the head and neck region. The current study demonstrates that this predictable pattern of metastasis can be significantly impacted by previous therapy, resulting in unusual patterns of metastasis in patients with recurrent tumors. A retrospective case series of 5 patients with head and neck carcinomas who developed metastases to distant lymph nodes is presented. All patients underwent surgery and radiotherapy to the primary tumor and regional lymphatics at the time of their initial treatment. All of the patients developed a local recurrence less than a year before the detection of distant lymphatic metastases. Cytology or excision confirmed metastases to the axillary, inguinal, or anterior intercostal lymph nodes. All of the patients underwent aggressive surgery for attempted cure of the local recurrence shortly before the presence of distant lymphatic metastases was clinically recognized. The metastatic workup of patients with carcinomas of the head and neck frequently includes examination of the regional lymph nodes as well as chest radiography, liver function tests, and serum calcium determination. This evaluation may fail to detect metastases to distant lymph nodes in patients who present with recurrent or second primary cancers. Such patients should undergo careful examination of all major lymph node-bearing regions of the body when being evaluated for the presence of distant metastases.     

Predicting Distant Failure in Nasopharyngeal Cancer

In a prospective study of 78 patients with nasopharyngeal cancer, we examined the prognostic significance of T stage, histology, parapharyngeal involvement, and lymph node dimensions, size, and level concerning distant metastasis. All patients were treated with radical radiotherapy alone and completed 3 to 7 years of follow-up. In univariate analysis of time to metastasis, there was a significant difference stratifying for T stage (T1 and 2 versus T3 and 4), node dimensions (less than 6 versus more than or equal to 6 cm), neck level (above versus below the thyroid notch), and parapharyngeal involvement, but not for bilaterality of lymphadenopathy. Histology was an important prognostic factor related to distant metastasis since none of the 24 World Health Organization class I cases showed distant metastasis versus 14 (26%) of 54 patients with World Health Organization class II/III carcinoma. A multivariate duration model of time to metastasis within the later histologic group suggested that lymph node dimensions, node level, and T stage were the most important factors related to distant metastases, with the hazard ratios being 3.98, 3.23, and 1.76, respectively. Multivariate analysis within the T3- to T4-stage group showed that node dimension was the only significant variable, with an associated hazard ratio of 4.09. Cases with upper-neck lymphadenopathy and node dimensions of less than 6 cm had a distant metastasis rate of <5%. We conclude that adjuvant chemotherapy for nasopharyngeal cancer is justified in T3- and T4-staged cases with nonkeratinizing or undifferentiated histology and with lymph nodes larger than 6 cm and/or located below the thyroid notch.     

内镜经口入路行鼻咽癌放疗后肿瘤残留切除或咽旁隙转移及复发淋巴结清扫术

 目的探讨内镜经口入路行鼻咽癌放疗后咽旁隙残留或复发淋巴结清扫术的有效性及可行性。方法回顾性分析2015年3月～2017年10月南方医科大学珠江医院耳鼻咽喉科收治的12例鼻咽癌放疗后咽旁隙淋巴结残留或复发患者的临床资料,所有患者术前均行影像学检查诊断,其中5例单纯行内镜下经口入路咽旁隙淋巴结清扫术,7例因有鼻咽癌原发灶残留或者复发同时行鼻咽-颅底肿瘤切除术。结果12例（共13侧）患者手术顺利,术后均未出现声嘶、进食呛咳及颈内动脉损伤等并发症,1例患者出现口内切口感染,1例患者切口部分缝线松脱,均经对症处理后痊愈。术后随访至2018年4月,中位随访23个月（6～36个月）,所有患者术后均未出现咽旁隙内再发转移灶。结论内镜下经口入路行鼻咽癌放疗后咽旁隙淋巴结清扫术可有效地切除转移灶,且手术创伤小,并发症少,术后恢复快,具有临床应用价值。     

Lymphocytic infiltration in undifferentiated nasopharyngeal cancer

BACKGROUND: Undifferentiated nasopharyngeal carcinoma (NPC) is characterized by prominent lymphocytic infiltration. Although the lymphoid infiltrate in NPC has been examined extensively in morphologic and immunocytochemical studies, the significance of this lymphoid infiltrate and its correlation with prognosis has been a subject of controversy for years. OBJECTIVE: To elucidate the significance of lymphoid infiltration in undifferentiated NPC. DESIGN: Evaluation of the relationship between lymphocytic infiltration in NPC and cervical lymph node status, ultrastructural examination of the lymphoid infiltrate, and assessment of lymphocytic infiltration as an independent prognosticator of regional node metastasis. MATERIALS AND METHODS: Lymphocytic infiltration was evaluated quantitatively in 20 cases of undifferentiated NPC using light microscopy. Four cases of undifferentiated NPC were processed for conventional electron microscopy. The effects of degree of lymphocytic infiltration, age, and tumor stage on cervical nodal metastasis were analysed using the logistic regression model. RESULTS: The degree of lymphoid infiltration correlated with cervical nodal metastasis (P<.001). Ultrastructural evidence of lymphocytes destroying cancer cells was seen. Lymphocytic infiltration was found to be an independent factor affecting cervical nodal metastasis (P =.02, univariate analysis; P =.03, multivariate analysis). CONCLUSIONS: The lymphoid infiltrate is beneficial in undifferentiated NPC, and its presence may deter regional metastasis of cancer cells to the cervical nodes.     

鼻咽癌调强适形放疗137例远期疗效及预后因素分析

目的：回顾性分析137例鼻咽癌调强适形放射治疗的远期疗效及预后影响因素。方法：对确诊的初治的无远处转移的137例鼻咽癌患者,采用三维适形调强放射治疗技术。在放疗后1个月按WHO实体瘤疗效评价标准进行近期疗效评价。放疗结束后2年内每3个月复查一次,2年后每6～12个月复查一次,常规进行临床查体、鼻咽镜、CT、B超、MRI、胸片、骨扫描检查,了解鼻咽腔、颈部淋巴结及颅神经情况。采用寿命表法计算总生存率,Kaplan-Meier方法计算无复发生存率、无远处转移生存率、无瘤生存率,用Log—rank检验法对14项可能影响预后的临床因素进行单因素分析,采用Cox风险比例模型做多因素分析,P〈0.05为差异有统计学意义。结果：①1、3、5年总生存率分别为98．5％、90．3％、74．6％,无复发生存率分别为97．0％、81．9％、66．7％无远处转移生存率分别为96．3％、80．5％、56．0％,元瘤生存率分别为95．6％、76．9％、43．8％;②单因素分析显示T分期、N分期、92福州临床分期、联合化疗、颅底骨质破坏、颅神经损伤、咽后淋巴结转移、疗终残留、总放疗时间等对预后的影响有统计学意义（均P〈0．05）;性别、族别、年龄、病理类型、贫血与否对预后的影响无统计学意义（均P〉0．05）;③将T分期、颅底骨质破坏、颅神经损伤、咽后淋巴结转移、N分期、联合化疗、疗终残留、总放疗时间、贫血与否引入Cox模型,结果表明N分期、联合化疗、颅神经损伤、疗终残留、总放疗时间是影响鼻咽癌预后的独立因素（均P〈0．05）。结论：鼻咽癌调强适形放射治疗较常规放疗有明显优势,在相关临床因素中N分期、颅神经损伤、联合化疗、疗终残留、总放疗时间是影响预后的最主要因素。     

鼻咽癌放疗后颈部淋巴结残留或复发对预后的影响

目的探讨鼻咽癌放疗后颈部淋巴结残留或复发对预后的影响。方法对67例鼻咽癌放疗后颈部淋巴结残留或复发而原发灶未复发的患者的临床病理资料进行回顾分析。选择性别、年龄、原发癌病理类型、残留或复发淋巴结大小、累及的侧数、淋巴结累及区域、累及区域数量、复发淋巴结的手术方式、颈动脉是否受侵、术后是否有严重并发症、是否补充放疗、是否复发、有无远处转移等临床病理因素,用χ2检验和Cox回归进行单因素和多因素分析,并用Kaplan-Meier法对残留和复发患者进行生存分析。结果单因素分析显示有无远处转移与预后明显相关,多因素分析结果表明,残留或复发淋巴结大小、是否累及Ⅴ区、残留或复发淋巴结累及区域数量、手术方式和有无远处转移与预后明显相关。Kaplan-Meier法进行生存分析显示颈部淋巴结残留或复发患者再次治疗的总1、3、5年生存率分别为88.6%、52.2%、38.6%,而采用根治性手术较采用局部手术生存率高。结论远处转移是影响鼻咽癌放疗后颈部淋巴结残留或复发患者预后的决定性因素。而残留或复发淋巴结大小、是否累及Ⅴ区、累及区域数量和手术方式也是重要因素,根治性手术可提高生存率。