鼻咽癌疗后骨转移程度对预后的影响

目的 分析鼻咽癌放化疗后骨转移程度对预后的影响。方法 回顾分析1997—2007年间在南方医院接受放化疗且疗后有骨转移的109例鼻咽癌患者的预后。Kaplan-Meier法计算生存率,Logrank法单因素预后分析,Cox回归模型多因素预后分析。结果 5年随访率为97.2%。全组患者1、2、3、5年总生存率分别为67.9%、48.6%、32.9%、17.4%。全组骨转移数≤3个(43例)与>3个(66例)的1、2、3、5年生存率分别为90.7%与53.0%、81.4%与27.3%、72.1%与6.2%、34.9%与4.2%(P=0.000)。骨转移数>3个中有与无合并其他部位转移的1、2、3、5年生存率分别为56.5%与72.1%、21.7%与30.2%、3.1%与13.0%、0.0%与6.5%(P=0.866)。多因素分析显示骨转移数目>3是影响预后的因素(P=0.000)。结论 鼻咽癌疗后骨转移灶数目增多是影响预后的重要因素,但是否需较积极治疗尚待探究以进一步完善鼻咽癌分期系统。

Prognostic impact of degree of bone metastasis in patients with nasopharyngeal carcinoma after radiochemotherapy

Objective To analyze the prognostic impact of degree of bone metastasis in patients with nasopharyngeal carcinoma (NPC) after radiochemotherapy. Methods A retrospective analysis was performed on the prognosis of 109 NPC patients who had bone metastases after radiochemotherapy in Nanfang Hospital from June 1997 to December 2007. The Kaplan-Meier method was used to calculate survival rates;the log-rank test was used for univariate prognostic analysis;the Cox regression model was used for multivariate prognostic analysis. Results The 5-year follow-up rate was 97.2%. The 1-, 2-, 3-, and 5-year overall survival rates for all patients were 67.9%, 48.6%, 32.9%, and 17.4%, respectively. The 1-, 2-, 3-, and 5-year survival rates for the 43 patients with not more than 3 bone metastases and the 66 patients with more than 3 bone metastases were 90.7% vs. 53.0%, 81.4% vs. 27.3%, 72.1% vs. 6.2%, and 34.9% vs. 4.2%, respectively (P=0.000). In the patients with more than 3 bone metastases, the 1-, 2-, 3-, and 5-year survival rates for those with and without other metastatic sites were 56.5% vs. 72.1%, 21.7% vs. 30.2%, 3.1% vs. 13.0%, and 0.0% vs. 6.5%, respectively (P=0.866). The multivariate analysis showed that more than 3 bone metastases were an adverse prognostic factor in the patients (P=0.000). Conclusions The number of bone metastases is an important prognostic factor in NPC patients after radiochemotherapy. Patients with not more than 3 bone metastases have better survival than those with more than 3 bone metastases, and aggressive treatment should be considered. In addition, the staging system of NPC needs to be improved.