中国鼻咽癌2008分期对口咽侵犯划分标准的临床验证

目的 临床验证中国鼻咽癌2008分期对口咽侵犯划分标准的合理性.方法 连续收集经病理证实的初治及无远处转移的鼻咽癌患者共333例,所有病例均行鼻咽部和颈部磁共振成像（MRI）扫描,评价鼻咽癌口咽侵犯情况.结果 333例鼻咽癌患者MRI显示,口咽侵犯26例（7.8％）.口咽侵犯的患者合并鼻腔、咽旁间隙、颅底骨质、翼内肌、鼻旁窦、颅内、翼外肌及其以外的咀嚼肌间隙侵犯的发生率明显增加（P＜0.050）.口咽侵犯患者较未发生口咽侵犯患者的5年总生存（OS）率及5年无远处转移生存（DFFS）率降低（38.1％比72.6％,P＜ 0.001;49.1％比84.5％,P＜0.001）.多因素分析显示：口咽侵犯是影响鼻咽癌OS率及DFFS率的独立预后因子（均P＜0.001）.口咽侵犯患者较T2期患者5年OS率及DFFS率降低（38.1％比80.9％,P＜ 0.001;49.1％比89.3％,P＜0.001）.结论 口咽侵犯是影响鼻咽癌患者OS及DFFS的重要因素.鼻咽癌口咽侵犯患者较T2期患者5年OS及DFFS明显下降.口咽侵犯在鼻咽癌2008分期中的划分标准有待于进一步修正.

A clinical verification on evaluation standard of the Chinese 2008 staging system of nasopharyngeal carcinoma for oropharynx involvement

Objective To clinically verify the rationality of evaluation standard of oropharynx involvement in the Chinese 2008 staging system for nasopharyngeal carcinoma （NPC）.Methods 333 consecutive patients with newly diagnosed,untreated,and nonmetastatic NPC were included.All patients had an MRI examnation of the nasopharynx and neck.The status of oropharynx involvement were evaluated.Results Of the 333 patients with NPC,26 （7.8 ％） patients presented with oropharynx involvement.Tumor invasion into oropharynx was highly related to tumor invasion into nasal cavity,parapharyngeal space,skull base,medial pterygoid muscle,paranasal sinuses,intracalvarium and masticator space excluding medial pterygoid muscle （P ＜ 0.050）.The oropharynx involvement was associated with poorer 5-year overall survival （OS） and distant failure-free survival （DFFS） （38.1％ vs 72.6 ％,P＜ 0.001 and 49.1％ vs 84.5 ％,P＜ 0.001,respectively）.By multivariate analyze,it was observed that oropharynx involvement was a significant predictive factor for OS and DFFS （P ＜ 0.001,P ＜ 0.001）.Significant differences were observed in the 5-year OS （38.1％ vs 80.9 ％,P ＜ 0.001） and DFFS rates （49.1％ vs 89.3 ％,P ＜ 0.001） between the patients with oropharynx involvement and stage T2 patients.Conclusions MRI-evidenced oropharynx involvement had a negative impact on OS and DFFS in NPC patients.The oropharynx involvement is associated with poorer 5-year OS and DFFS compared with stage T2.The evaluation standard of oropharynx involvement for NPC in the Chinese 2008 staging system could be revised.