鼻咽癌治疗后局部复发回顾性研究

目的 鼻咽癌治疗后局部复发为主要失败模式之一,本研究分析无远处转移鼻咽癌(nasopharyngeal carcinoma,NPC)患者临床特征与治疗后鼻咽局部复发的关系,为指导临床治疗及提高局部控制提供依据.方法 收集2000-01-01-2004-12-31汕头大学医学院附属肿瘤医院1 338例病理确诊无远处转移行首程根治性治疗NPC患者临床特征,率的比较采用卡方检验;生存指标、单因素分析采用Kaplan-Meier法;多因素分析采用Cox回归分析.结果 治疗后随访5、10和15年复发比例分别为10.4％、11.9％和12.0％,累计鼻咽复发风险分别为12.7％、15.5％和16.6％;中位复发间隔时间为28个月.单因素分析结果表明,鼻咽癌鼻咽复发的危险因素包括放疗剂量、疗程延长、未行化疗、颅底骨破坏、副鼻窦受侵和颅神经损伤.Cox风险比例逐步回归多因素分析结果显示,影响NPC患者鼻咽复发的独立预后不良因素为未行化疗和颅底骨质破坏,P＜0.05.结论 NPC患者治疗5年后长期随访仍可出现鼻咽复发,提示与NPC患者侵犯部位和生物学行为有关,联合化疗与长期随访策略可能是有效防治措施.

Distant metastasis of nasopharyngeal carcinoma after treatment:A 15-year follow-up study

OBJECTIVE To study the relationship between clinical features and local recurrence of nasopharyngeal carcinoma patients without distant metastasis,and to provide evidence for clinical treatment and local control.METHODS From January 1 2000 to December 31 2004,1 338 nasopharyngeal carcinoma patients who had no distant me tastasis confirmed by pathology and received radical treatment as a first-line treatment were included in the study,and their clinical features were recorded.Rates were compared by Chi-square test.The Kaplan-Meier method was used for univariate survival analysis,with Cox regression analysis for multivariate analysis.RESULTS The 5-year,10-year and 15-year-follow-up recurrence ratios were respectively 10.4％,11.9％ and 12.0％,with the cumulative risks of nasopha ryngeal recurrence of 12.7％,15.5％ and 16.6％,respectively.The median recurrence interval time was 28 months.The univariate survival analysis indicated that the risk factors of nasopharyngeal recurrence after treatment were radiation dosage,prolonged treatment time,no chemotherapy,basicranial bone destruction,paranasal sinus invasion and cranial nerve injury.Multivariate Cox proportional hazard regression analysis indicated that no chemotherapy and basicranial bone destruction were the adverse independent prognostic factors(P＜0.05).CONCLUSIONS Through the long-term followup,nasopharyngeal recurrence could be observed more than 5 years after treatment,suggesting that it was associated with the invasion sites and biological behavior of nasopharyngeal carcinoma.The protocol with adjuvant chemotherapy and long-term follow-up may be effective for prevention and treatment.