鼻咽癌的远处转移

DISTANT METASTASES IN NASOPHARYNGEAL CARCINOMA

本文分析了经放射治疗后随访五年以上的511例鼻咽癌,其中发生远处转移的有103例,远处转移率为20.2%。骨、肺、肝是最常见转移部位.骨转移又以脊柱、骨盆、四肢骨为多.影响远处转移主要因素是颈淋巴结转移,其次是原发肿瘤侵犯口咽或鼻腔。随着颈淋巴结增大,远处转移机会亦明显增加。远处转移是鼻咽癌最主要的死亡原因,因此早期发现和早期治疗是防止远处转移有效方法之一。

511 consecutive cases of nasopharyngeal carcinoma treated by radiotherapy wereanalysed.276 out of 511 patients survived over 5 years,a 5-year survival rate of54.0%.103 cases(20.2%)developed distant metastases.The commonest metastaticsites were bone(38.7%),lungs(19.7%)and liver(17.5%).Skeletal metastases usuallyoccurred in the form of multiple metastatic lesions with special preference for spinalcolumn,pelvis and long bone.The probability of developing distant metastases wasinfluenced by the status of the cervical lymph nodes and by the extension of primarytumor into oropharynx or nasal cavity.The incidence of distant metastases increasedas the size of cervical metastatic node increased.The prognosis of nasopharyngeal car-cinoma with distant metastasis is poor,the overall median survival being four months.Distant metastasis is the main cause of death.In our series,9 cases developed distantmetastasis during the course of radiotherapy,46 cases developed one year after irradia-tion and 22 cases two years after irradiation.The authors emphasized that patientswith nasopharyngeal carcinoma could have subclinical metastasis and application ofappropriate chemotherapy after radiotherapy might diminish the frequency of distantmetastasis.