鼻咽癌放射治疗或放射化学治疗后颈淋巴结残留或复发的颈淋巴结清扫术△

目的 探讨不同颈淋巴结清扫术(简称颈清扫术)对鼻咽癌放射治疗(简称放疗)或放射化学治疗(简称放化疗)后颈淋巴结残留或复发的影响。方法 回顾分析我院2006年2月~2017年12月收治的57例鼻咽癌放疗或放化疗后颈淋巴结残留或复发患者的临床资料,采用Kaplan-Meier法、卡方检验、Log-Rank检验和Cox风险回归模型分析不同颈清扫术及其他临床特征对患者预后的影响。结果 57例患者中,术后病理确诊淋巴结阳性45例、阴性12例。淋巴结阳性患者行根治性颈清扫术或行择区性颈清扫术,3年和5年总生存率(OS)、无病生存率(DFS)差异均无统计学意义(P值均>0.05)。多因素分析显示,性别、阳性淋巴结大小、术前淋巴结N分期为影响患者预后的独立因素(P值均<0.05)。结论 残留或复发淋巴结N分期是影响鼻咽癌患者预后的独立因素,应根据颈淋巴结分期、放疗后颈部条件及医师临床经验选择合适的术式。

Neck dissection for the residual or recurrent cervical lymph nodes of nasopharyngeal carcinoma after radiotherapy or radiochemical therapy

Objective To explore the effects of different neck dissection (ND) on cervical lymph nodes residue or recurrence in patients with nasopharyngeal carcinoma (NPC) after radiotherapy or radiochemical therapy. Methods From February 2006 to December 2017, the clinical data of 57 patients with residual or recurrent cervical lymph nodes of NPC after radiotherapy or radiochemical therapy in our hospital were analyzed retrospectively. Kaplan-Meier method, Chi-square test, log-rank test and Cox risk regression model were used to analyze the difference in the different neck dissections and other clinical features on the prognosis. Results In the 57 cases, 45 cases had positive lymph nodes confirmed by postoperative pathology and 12 cases were negative. In the patients with positive lymph nodes, there were no significant differences in overall survival (OS) or disease-free survival (DFS) between the radical ND and the selective ND (P>0.05). Multivariate analysis showed that sex, the diameter of positive lymph nodes and preoperative lymph node N classification were the independent prognosis factors respectively (P<0.05). Conclusions The N classification of preoperative residual or recurrent lymph node was an independent factor for the prognosis of patients with NPC. The appropriate ND should be selected according to the stage of cervical lymph node, the neck condition after radiotherapy and the clinical experience of the physician.