鼻咽癌咽后淋巴结转移规律对放疗靶区设计的影响

目的 探讨鼻咽癌咽后淋巴结的转移规律，为优化鼻咽癌的靶区勾画提供依据。方法 收集我院2009年1月~2017年12月初诊的190例鼻咽癌患者的临床资料，分析咽后淋巴结转移的影像学特征及与分期的关系。结果 190例鼻咽癌患者中有121例出现咽后淋巴结转移，咽后淋巴结转移率为63.68%。121例患者咽后淋巴结均分布于外侧组，无内侧组淋巴结转移；其中单侧转移者66例（54.54%），双侧转移者55例（45.45%）；淋巴结的中心位置最主要分布于C1椎体。不同T分期、N分期及临床分期咽后淋巴结转移率比较，差异有统计学意义（P＜0.05）。结论 鼻咽癌咽后淋巴结主要以外侧组转移为主，中心位置主要位于C1椎体，咽后淋巴结的转移可能与分期相关。咽后淋巴结内侧组转移率较低，IMRT时可不进行预防性照射。

Effect of Post-Pharyngeal Lymph Node Metastasis on the Design of Radiotherapy Target Area in Nasopharyngeal Carcinoma

Objective To investigate the metastasis of the posterior pharyngeal lymph nodes in nasopharyngeal carcinoma and provide a basis for optimizing the target area of nasopharyngeal carcinoma. Methods The clinical data of 190 patients with nasopharyngeal carcinoma who were newly diagnosed in our hospital from January 2009 to December 2017 were collected. The imaging features of post-pharyngeal lymph node metastasis and their relationship with staging were analyzed. Results Of the 190 patients with nasopharyngeal carcinoma, 121 had post-pharyngeal lymph node metastasis, and the rate of post-pharyngeal lymph node metastasis was 63.68%. In the 121 patients, the posterior pharyngeal lymph nodes were distributed in the lateral group, and there was no medial lymph node metastasis. Among them, 66 patients (54.54%) had unilateral metastasis and 55 patients (45.45%) had bilateral metastasis. The central location of lymph nodes was mainly distributed in C1 vertebral body. There were significant differences in the rate of lymph node metastasis between different T stages, N stages and clinical stages (P<0.05).Conclusion The posterior pharyngeal lymph nodes of nasopharyngeal carcinoma are mainly metastasis in the lateral group. The central location is mainly located in the C1 vertebral body. The metastasis of the posterior pharyngeal lymph nodes may be related to the staging. The rate of metastasis in the medial group of the posterior pharyngeal lymph nodes is low, and prophylactic irradiation is not available at IMRT.