鼻咽未分化癌的疗效分析

Undifferentiated Nasopharyngeal Carcinoma: Analysis of 46 Cases

目的:分析鼻咽未分化癌的治疗方法治疗效果。方法:鼻咽未分化癌46例,其中I期1例,II期5例,III期25例,IV期15例。37例根治性放疗中,19例行放疗+化疗(9例联合用药,10例单药化疗),18例行单纯放疗;9例因已出现远处转移或治疗中自行放弃行姑息性放疗。采用Kaplan-Meier方法进行生存率分析,显著性差异采用Log-rank检验。结果:①全组1、3、5、10年生存率分别为80.9%、47.6%、35.7%、28.6%,中位生存期为32个月。按分期的生存率曲线差异有显著性(P=0.0005)。②根治性放疗组中,局部控制率为75.7%(28/37例),局部病灶控制与否对生存曲线的影响有显著性差异(P=0.0417)。根治性放疗+联合化疗与单纯根治性放疗的1、3、5、10年生存率分别为100%、75%、75%、62.5%和75%、50%、31.3%、25%,鼻咽未分化癌根治性放疗+联合化疗疗效好于单纯根治性放疗(P=0.0811)。③姑息治疗的生存情况是1年生存率为55.5%(5/9例),无2年以上生存者。结论:①鼻咽未分化癌进展快,发生远处转移早,生存率差。②放射治疗敏感,是主要的有效方法;未发生远处转移的鼻咽未分化癌根治性放疗+联合化疗可提高生存率。

Abstract：Objective：To evaluate the therapeutic efficacy of combination of chemotherapy in 46 undifferentiated nasopharyngeal carcinoma. Mothods： Forty-six cases of undifferentiated nasopharyngeal carcinoma were treated, 1 case had stage Ⅰ lesion, 5 had stage Ⅱ lesions, 25 had stage Ⅲ lesions and 15 had stage Ⅳ lesions. In 37 patients receiving radical irradiation, 18 were treated by only radiotherapy and 19 cases by radiotherapy plus chemotherapy（10 cases cisplatin-based combination, 9 cases only cisplatin）. Nine patients received palliative irradiation due to distant metastasis before treatment or abandoning by themselves. Kaplan-Meier method was used in the survival analysis and the Log-rank test to inspect into possible differences. Results： ① The survival rate of the whole group in 1-,3-,5-and 10-year were 80.9%,47. 6%,35.7%,28.6%, respectively, Median survival time was 32 months. ② The 1-, 3-, 5- and 10-year survival rate for radical irradiation plus combination chemotherapy or unique radical radiotherapy were 100%, 75%, 75%, 62.5% and 75%, 50%, 31.3%, 25% respectively（P=0.0811）. The local control rate of the tumor was 75.7%, it did affect survival rate（P=0. 0417）. ③ The 1 year survival rate for palliative irradiation was 55.5 %, and there was no case of 2-year survival. Conclusion：① Undifferentiated nasopharyngeal carcinoma is quickly matastatic with rather poor prognosis. ②The radiotherapy is still one of major and efficient treatments for undifferentiated nasopharyngeal carcinoma, it can raise the local control rate of tumor and improve survival rate with cisplatin-based combination chemotherapy.