464例鼻咽癌分期与就诊原因Logistic回归分析

Relationship between Clinical Staging and Presenting Symptom in 464 Patients with Nasopharyngeal Carcinoma

目的探讨鼻咽癌患者就诊原因与鼻咽癌分期的关系。方法收集2002年1月1日至2003年12月31日在我院初次住院治疗的鼻咽癌患者464例临床资料进行回顾调查和分析。结果病人就诊原因多种多样,主要有:涕血(回吸性)、耳鸣及听力减退、颈部肿物、鼻塞、头痛、颅神经损害症状、体检发现等。其中体检发现2例,仅表现为涕血37例,颈部肿物80例。就诊原因与鼻咽癌分期关系有序分类Logistic回归分析,鼻塞、耳鸣及听力减退,颈部肿物、头痛、颅神经损害症状有统计显著性意义。结论鼻咽癌分期不同就诊原因明显不同,Ⅰ、Ⅱ期鼻咽癌症状大多局限于耳部或鼻咽部,或二者兼有,以及上颈部小结节等,且有19.3%患者仅表现为涕血,18·7%表现为颈部肿物,提示临床医生当发现上述症状时,特别是原因不明,不能解释的单侧症状者,以及高危人群,均应警惕鼻咽癌的可能,及时给予相应的检查,以免延误诊断。

Objective To discuss the relation between tumor staging and presenting symptom in nasopharyngeal carcinoma（ NPC）. Methods From Jan 2002 to Dec 2003,464 patients with NPC received initial treatment in our hospital were retrospectively reviewed. Results The most common presenting symtom included： epistaxis, tinnitus, hearing loss, neck mass, nasal obstruction, headache, dysfunction of cranial nerves . 2 patients were diagnosed by routine medical ex- amination without any symptom. Epistaxis is the only symptom in 37 patients, and neck mass in 80 patients. The relation- ship between presenting symptom and tumor staging was evaluated by ordinal classification logistic regression analysis. The difference in symptom of nasal obstruction, timlitus, hearing loss, neck mass, headache, dysfunction of cranial nerves was statistically significant. Conclusion The NPC staging varied from different presenting symptoms. Symptoms of NPC patient in clinical staging Ⅰ and Ⅱ usually locallied in ear , nasopharynx and upper cervical nodule. Incidences of epistaxis or neck mass were 19.3% and 18.7%. If we found patient with the similar symptoms, especially with occult, inexplicable unilateral symptom, or in high risk population, we should think about the possibility of NPC, and take the clinical examination to confirm the diagnosis.