鼻腔癌临床TNM新分期的研究

New clinical staging system for carcinoma of nasal cavity

目的根据对目前几种主要鼻腔癌临床分期的分析,提出新的临床分期标准。方法运用122例鼻腔癌患者的临床资料,对目前主要的鼻腔癌临床分期进行分析。并结合临床资料,通过计算机优化和筛选,提出新的临床分期。生存分析采用Kaplan-Meier法,多因素分析采用Cox回归模型。结果根据新的临床分期标准,本组122例中,T1期16例,T2期32例,T3期42例,T4期32例,其5年生存率分别为78.8%,64.6%,49.9%和30.0%;Ⅰ期患者16例,Ⅱ期患者26例,Ⅲ期患者45例,Ⅳ期患者35例,其5年生存率分别为78.8%,68.4%,51.3%和29.0%。全组总的5年生存率为61.6%。新的临床分期标准结合了现代影像学技术,与现有各分期比较,更符合TNM分期的一般原则,各期例数分布均匀,生存曲线有显著差异。结论新的临床分期标准在各项参数上均优于现存的鼻腔癌各临床分期法,值得临床应用和推广。

Objective To establish a new staging system based on analysis of several presently used clinical staging systems for carcinoma of nasal cavity. Methods The data of 122 patients treated from 1985 to 1997 in the cancer center of Sun Yat sen University were analyzed, and a new clinical staging system was established using computer optimizing and screening combined with the clinical results. The survival analysis was performed by Kaplan Meier estimates, and the multivariate analysis was achieved by Cox proportional hazard model. Results The flaws in the presently used clinical staging systems proposed by Zhuang, Qiu, Department of Head and Neck of Cancer Center of Sun Yat sen University and University of Florida and the AJCC′2002, were as follows: insufficient consideration of the modern tomography resulting in indefinite location of the tumor in clinical practice, the uneven distribution of patients in different stages, being unable to separate survival curves of different stages, and not containing of all necessary clinical staging information in some staging systems. However, based on our new staging system, the cases distributed in T1, T2, T3 and T4 was 16, 32, 42 and 32, and the 5 year survival rate was 78.8%,64.6%,49.9% and 30.0%, respectively. The cases distributed in stage Ⅰ, Ⅱ, Ⅲ and Ⅳ was 16, 26, 45 and 35, and the 5 year survival rate was 78.8%,68.4%,51.3% and 29.0%, respectively. The overall 5 year survival rate was 61.6%. Conclusion Compared to the presently used clinical staging systems, the new staging system may have more advantages in various parameters for the clinical staging in the carcinoma of nasal cavity, and may be worth to be widely and clinical used.