406例鼻咽癌患者颈部及Ⅴ区后缘间隙淋巴结转移的预后分析

  目的  回顾性分析鼻咽癌患者伴有颈部及Ⅴ区后缘间隙淋巴结转移的预后情况，为颈部淋巴结分区及鼻咽癌N分期的进一步修订提供参考。  方法  选取2011年12月至2016年6月成都军区总医院经病理确诊为鼻咽癌的患者406例，分析伴有颈部及Ⅴ区后缘间隙淋巴结转移患者的预后情况。  结果  406例患者的5年总生存率（overall survival，OS）、无进展生存率（progressionfree survival，PFS）、无局部复发生存率（local relapse-free survival，LRFS）、无远处转移生存率（distant metastasis-free survival，DMFS）分别是75.0%、63.4%、87.2%和81.8%。伴有Ⅴ区后缘间隙淋巴结转移患者的3年OS、PFS、LRFS、DMFS分别是51.5%、22.7%、90.0%和41.3%。N3期患者伴或不伴有Ⅴ区后缘间隙淋巴结转移的3年OS、PFS、LRFS、DMFS分别是43.9%和84.7%（P=0.002）、12.9%和55.4%（P=0.006）、88.9%和80.3%（P=0.649）、33.0%和85.9%（P＜0.001）。单因素分析显示N分期是影响OS、PFS、DMFS的预后因素（P＜0.05），多因素分析显示Ⅴ区后缘间隙淋巴结转移是影响DMFS的独立预后因素（P＜0.05）。  结论  鼻咽癌患者伴有Ⅴ区后缘间隙淋巴结转移预后差，且该区淋巴结转移预示患者远处转移的风险增加。建议将Ⅴ区后缘间隙作为头颈部肿瘤一个新的颈部分区。 

Prognosis of cervical and posterior to level V lymph node metastasis in 406 cases of na-sopharyngeal carcinoma

Objective:To investigate the prognosis of cervical and posterior to level V (PLV) lymph node metastasis and discuss further updates on neck levels and N stages for nasopharyngeal carcinoma (NPC). Methods:A total of 406 pathologically diagnosed NPC cases from December 2011 to June 2016 were retrospectively analyzed. SPSS 20.0 was used to analyze the prognosis of patients with cervi-cal and PLV lymph node metastasis. Results:In the 406 cases, the 5-year overall survival (OS), progression-free survival (PFS), local re-lapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were 75.0%, 63.4%, 87.2%, and 81.8%, respectively. The 3-year OS, PFS, LRFS, and DMFS of patients with node involvement of PLV were 51.5%, 22.7%, 90.0%, and 41.3%, respectively. For the N3 stage, the 3-year OS, PFS, LRFS, and DMFS with or without PLV involvement were 43.9%and 84.7%(P=0.002), 12.9%and 55.4%(P=0.006), 88.9%and 80.3%(P=0.649), and 33.0%and 85.9%(P<0.001), respectively. Univariate analysis showed that N stage was a prog-nostic factor for OS, PFS, and DMFS (P<0.05). Multivariate analysis demonstrated that PLV was an independent prognostic factor for DMFS (P<0.05). Conclusion:Patients with NPC with PLV node involvement exhibited poor prognosis and an increased risk of distant metastasis. Thus, PLV should be a new neck node level for head and neck tumors.