鼻咽癌Ⅲ/Ⅳ期152例的预后因素分析

Prognostic factors of 152 cases with Ⅲ/Ⅳ stage nasopharyngeal carcinoma

目的:比较超分割加同期化疗与单纯超分割放疗治疗Ⅲ/Ⅳ期鼻咽癌的生存率,并分析其预后因素。方法:144例鼻咽低分化癌患者随机分入超分割加同期化疗组(放化疗组)与单纯超分割放射治疗(单放组)。两组放射治疗方式相同,1.2Gy/次,2次/d。研究组在放射治疗前、中加用化疗,放疗与化疗同期进行。结果:5年生存率放化疗组和单放组分别为63.3%及50.7%。影响患者预后的因素为N分期、化疗及放射治疗中血红蛋白量的水平。单放组血红蛋白正常患者可获得血红蛋白异常组加用化疗的相近效果。结论:超分割放射加同期化疗治疗Ⅲ/Ⅳ期鼻咽癌能提高生存率。化疗对N2、N3的患者影响更大。多因素回归法分析N分期、是否加用化疗和放射治疗中血红蛋白量是否正常是影响预后的独立因素。

Purpose：To compare the survival rates of hyperfractionated radiotherapy plus concnrrent chemotherapy with hyperfractionated radiotberapy alone in the treatment of stage Ⅲ/Ⅳ nasopharyngeal carinomu（NPC）and analyze the prognostic factors.Methods：Between December 1992 and December 1995,144NPC patients were randumized into hyperfractionated radiotherapy plus concurrent chemotherapy（R＋C）and hyperfractionated radiotherapy alone（R alone）.Radiotherapy were similar in the two groups：1.2 Gy/f.twice a day.Chemotheapy was given to R＋C paticnts before and during the course of radiotherapy.Results：The 5-year overall survival rates of the R＋C and R alone groups were 63.3% and 50.7%,repectively.The factors influeneing the results were N stage,chemotherapy and the peripheral blood hemoglobin concentration.Conclusions：Hyperfractionated radiotherapy plus concurrent chemotberapy can improve the survival rate.especially for the patients with N2-N3 stage.The negative prognostic factors for Ⅲ/Ⅳ NPC are N2-N3 stag,radiotherapy alonc and the reduction of hemoglobin during treatment.