鼻咽癌UICC分期(1997)的临床评价

目的：评价鼻咽癌UICC（1997）分期的预后预测价值。方法：1992年8月至1993年12月，本院621例经鼻咽活检证实，治疗前均行CT或MR检查的MO鼻咽癌患者，根据UICC（1997）分期，对621例病人重新分期。放射治疗：NPDT：66-74Gy/33-37次，共7-8周；LNDT：60-70Gy/33-35次，共7-8.5周；颈部预防量：48-50Gy。结果：Ⅰ-Ⅳ期的病例分别为6.1%、43.5%、25.1%及25.3%。本组病例咽旁侵犯的发生率为74.1%，在460例咽旁侵犯的病例中，310例（67.4%)划分为T2。Ⅰ-Ⅳ期的5年生存率分别为89%、70%、53%及37%；Ⅰ-Ⅳ期的5年无瘤生存率分别为84%、69%、51%及36%。T1-4的5年无局部复发生存率分别为93%、84%、71%及58%；N1-4的5年无远处转移生存率分别为90%、81%、62%及51%。结论：UICC（1997）分期能较好的预测鼻咽癌预后，然而，病例分布不合理，Ⅱ期病人占总病例的43.5%。建立下一版UICC鼻咽癌分期进行咽旁侵犯程度的划分。

Clinical Evaluation of 1997 UICC Staging System for Nasopharyngeal Carcinoma

Objective：The fifth edition of the International Union Against Cancer (UICC) staging manual defines new rules for classifying nasopharyngeal carcinoma (NPC). The study was conducted to assess the effectiveness of the manual to predict the prognosis for Chinese patient populations. Methods：From August 1992 to December 1993, a total of 621 consecutively admitted patients with nondisseminated NPC were treated with definitive-intent radiation therapy alone. A computer database containing all information for staging was formed on presentation. The extent of disease of each patient was restaged according to the 1997 UICC system. Results：The 1997 UICC system creates subgroups (Stages Ⅰ -Ⅳ ) that are assigned to 38 (6.1％ ), 270 (43.5％ ), 156 (25.1％ ), and 157 (25.3％ ) patients, respectively. The incidence of parapharyngeal extension was 74.1％ (460/621). Of these patients (460) with parapharyngeal extension, 310 (67.4％ ) patients were classified as T2 disease, The 5-year Overall survival(OS) rates were 89％ , 70％ , 53％ , and 37％ for Stages Ⅰ -Ⅳ , respectively. The 1997 UICC system showed highly significant differences between the overall stages for both OS and relapse-free survival(RFS). The 1997 UICC T-classifications showed significant correlation with local failure, and N classification was accurate in predicting freedom from distant metastasis(FDM). Conclusion：The 1997 UICC staging system for NPC is prognostically useful for Chinese patient populations. However, an uneven patient number distribution was noted. Subdivision of parapharyngeal extension should be included in future revisions of the staging system.