48例行颈部淋巴结活检术的鼻咽癌预后分析

目的分析已行颈部淋巴结活检鼻咽癌疗效的预后影响因素。方法2006年1月至2006年12月，本院共收治48例治疗前已行颈部淋巴结切取或活检的鼻咽癌病例，鼻咽病理均确诊为鼻咽未分化型非角化性或角化性癌，均采用常规根治性放疗，部分病例给予放化综合治疗。结果全组复发率14．5％，远处转移率52．1％，4年总生存率43．6％；单纯放疗组和放化疗组的4年远处转移率分别73．3％、42．4％（P〈O．05），生存率分别为26．3％、55．2％（P〈0．05）;活检术与放疗间隔时间≤15天组和〉15天组的4年远处转移率分别37．9％、73．7％（P〈0．05），生存率分别为54．5％、20．0％（P〈0．05）;活检淋巴结剂量〉64Gy和活检组淋巴结剂量≥64Gy的4年远处转移率分别75．0％、40．6％（P〈0．05），生存率分别为25．0％、53．1％（P〉0．05）。结论颈部淋巴结活检术后预后差，应尽早治疗，可考虑放化综合治疗，放疗剂量应≥64Gy，由于本研究观察时间短，病例数有限，其远期结果有待于更多临床资料的积累和更长时间的观察。

Analysis on the prognosis 48 nasopharyngeal cancer patients taken lymph node biopsy

Objective To explore the influence facter of neck lymph node biopsy on the prognosis for NPC.Methods 48 NPC cases taken cervica lymph node metastases were treated by radiotherapy from January,2006 to December,2006.Analyzed recurrence and 4-year survival rates.Results The rates of recurrence and distant metastasis were 14.5％ and 52.1％; and overall 4-year survival rate was 43.6％ in the 48 cases.The rate of metastasis was 73.3％ in Radiotherapy alone group(Group A),and 42.4％ in chemotherapy group(Group B)(P=0.015); and overall 4-year survival rates were 26.3％ and 55.2％,respectively in the both groups(P=0.049).The metastasis rate was 37.9％ in the patients treated within 15 days( Group C ),while 73.7％ beyond 15 days(Group D) (P=0.047); and overall 4-year survival rates were 54.5％ and 20.0％,respectively in the both groups(P=0.025); The metastase rates were 75.0％ for the dose of cervical lymph node under 64Gy(Group E),and 40.6％ for the dose above 64 Gy (Group F),P=0.025;and overall 4-year survival rates were 25.0％ and 53.1％,P=0.064.Conclusion The neck lymph node biopsy can increase the rate of distant metastasis and decrease the rate of survival for NPC,so early radiotherapy,chemotherapy,and the dose above 64Gy can improve the clinical effect of NPC.The longterm treatment result need enrolling more patients and long-term follow-up.