鼻咽癌放疗后颈转移淋巴结手术治疗及预后

Salvagesurgeryforcervicalmetastasisfromnasopharyngealcarcinomaafterradiotherapy

为分析鼻咽癌放疗后颈淋巴结残留和复发的手术治疗疗效及影响预后因素，对１４０例患者的治疗进行了回顾性分析。术后３年、５年颈部局部控制率为４８．３％和２７．３％，３年、５年无远处转移生存率为４４．５％和２５．６％，３年、５年总生存率为５０．１％和２７．３％。多因素分析结果表明：淋巴结大小、淋巴结包膜外侵犯是影响颈部局控率、总生存率的独立预后因素，影响无远处转移生存率的因素仅为淋巴结大小。死亡原因主要为远处转移（４８．９％），其次为原发灶复发（２６．７％）和颈部术后复发（１４．４％）。认为鼻咽癌放疗后颈转移灶的挽救性手术积极有效，能明显提高患者的颈部局控率、无远处转移生存率及总生存率。术后再放射治疗及辅助化学治疗例数较少，应加强和总结。

Onehundredandfortypatientswhohadresidualorrecurrentlymphnodemetastasisfromnasopharyngealcarcinomaafterradiotherapyunderwentsalvagesurgery.Theoveral3and5yearsurvivalrateswere50.1%and27.3%,the3and5yearlocalcontrolrateswere48.3%and27.3%,the3and5yearsdistant-metastasis-freerateswere44.5%and25.6%respectively.Themostsignificantfactorsinfluencingsurvivalandlocalcontrolrateswerethesizeandtheinvolvementofthecapsuleofthelymphnodes.Thesizeofthelymphnodewastheonlyinfluencingfastorfordis-tant-metastasis-freesurvival.Distantmetastasiswasthemostfrequentfactoroftreatmentfailure(48.9%)folowedbyrecurrenceofneckmass(14.4%).Theauthorsconsideredthatthesalvagesurgeryisanefectivemethodinimprovingthesurvivalrate.Thereradiotherapyaftersurgeryor/andadjuvantchemotherapyisanewareaforfurtherinvestigation.