鼻咽癌局部扩散与远处转移的相关性

目的:探讨鼻咽癌局部和区域扩散与远处转移的相关性。方法:分析204例鼻咽癌初治患者的临床资料(其中放疗后无瘤生存≥5年者101例,为无瘤组;放疗后远处转移者103例,为转移组),重新阅读其治疗前CT片,确定局部扩散范围和方式,并进行单因素和Cox模型分析。结果:单因素分析表明,鼻窦侵犯,颅底破坏,脑神经损害,咽旁间隙侵犯程度,颈淋巴结转移侧数、个数、大小及活动度,临床分期,T分期与N分期均具有统计学意义(均P<0.05);多因素分析只显示鼻窦侵犯,脑神经损害,颈淋巴结转移侧数、个数和大小,临床分期具有统计学意义;对局部扩散各种因素与区域扩散相关性分析显示,无论是局限性病变,还是颅底、咽旁间隙等扩散,转移组并区域淋巴结转移及其转移程度(N2,3)均明显高于无瘤组(P<0.05或P<0.01)。结论:区域淋巴结转移及其程度是鼻咽癌放疗后远处转移最主要、最恒定的因素,原发灶局部扩散主要是通过区域淋巴结转移来影响远处转移。

Correlation between infiltration of local lesion and distantmetastasis of nasopharyngeal carcinoma

Objective:The aim of this study was to study the correlation between local and regional infiltration and distant metastasis of nasopharyngeal carcinoma(NPC).Method:Materials of 204 NPC cases primarily treated(including 101 cases with tumor free and a period of survived time for 5 or more years after radiotherapy and 103 cases with distant metastasis after radiotherapy).The extent and the way of local aggressiveness were made sure by studying their CT.Then the single-factor and COX analysis were adopted to analyze.Result:Single-factor analysis showed the extent of aggressiveness of nasal sinuses,base of skull,cranial nerves,parapharyngeal space,laterals and number,size,fixation of neck lymph nodes of metastasis,clinical stage,T and N stage had statistical significance(P<0.05);Muti-factor analysis merely showed aggressiveness of nasal sinuses,cranial nerves,laterals and number,size of neck lymph nodes,clinical stage had statistical significance;Analysis of correlation between the situations of local aggressiveness and regional infiltration showed that the occurrence of metastasis of lymph nodes and its degree in metastasis group of post-radiotherapy was obviously higher than that in non-metastasis group(P<0.05,P<0.01),while the degree of local aggressiveness,the involvement of base of skull and the parapharyngeal space were not.Conclusion:Regional infiltration and its degree are the most important and stable factors that affect the distant metastasis in NPC patients after radiotherapy,and primary lesion intrigues distant metastasis mainly through occurrence of metastasis of regional lymph nodes.