鼻咽癌颅神经受累的临床意义

Significcance of cranial nerve involvement shown by the prognosis of nasopharyngeal carcinoma

目的分析鼻咽癌颅神经受累情况及其与预后的关系,并进一步探讨鼻咽癌颅神经受累对临床治疗的意义。方法回顾性分析935例首程治疗的鼻咽癌患者,以初次就诊时的症状和临床查体有无颅神经受累将患者分为颅神经受累组和未受累组。分析颅神经受累对预后的影响。结果全组颅神经受累率为20．0%,以第5对颅神经受累最常见。颅神经受累组与未受累组5年局部复发率分别为20．1%和16．8%(P=0．465)。在颅神经受累患者中,颅底照射剂量＜70、70～79、≥80 Gy组5年局部复发率分别为38．1%、24．5%和16．0%(P=0．082)。颅神经受累组与未受累组5年远处转移率分别为31．6%和19．5%(P=0．020),5年总生存率分别为62．2%和78．1%(P=0．000),无瘤生存率分别为43．2%和62．4%(P=0．000)。多因素分析显示颅神经受累是影响总生存率和无瘤生存率的独立预后因素,其相对危险度分别为1．62(95%CI=1．11～2．53,P=0．001)和1．40(95% CI=1．05～1．88,P=0．020)。结论鼻咽癌颅神经受累者5年远处转移率显著增加,并导致5年总生存率和无瘤生存率显著降低。适当提高局部剂量有望提高局部控制率。放化结合的综合治疗可能对这部分患者有应用价值。

Objective To analyze the cranial nerve involvement in nasophryngeal carcinoma and its relationship with the prognosis with the optimal treatment for such patients studied also. Methods 935 untreated nasopharyngeal carcinoma patients, admitted into our hospital from January 1990 to June 1999, were analyzed retrospectively. These patients were divided into cranial nerve involved group and cranial nerve uninvolved group by patients symptoms signs and/or images before the treatment. SPSS10.0 soft package was used to analyze the effect of cranial nerve involvement on the prognosis. Results The overall percentage of cranial nerve involvement was 20.0%, of which the trigeminal nerve was most common . The 5-year local recurrence rate was 20. 1% and 16.8% （P = 0. 465 ） in cranial nerve involved group and un-involved group, respectively. In the patients with cranial nerve involved, the 5-year local recurrence rates of patients who received boost skull base irradiation dose 〈70, 70-79 and I〉80 Gy was 38.1% , 24.5% and 16.0% （ P = 0. 082 ） , respectively. The 5-year distant metastasis rate was 31.6% and 19.5 % （ P = 0. 020） in cranial nerve involved group and un-involved group. The corresponding overall survival rates and disease-free survival rate was 62.2% and 78. 1% （P =0. 000） and 43.2% , 62.4% （P =0. 000） ,respectively. By multivariate analysis, cranial nerve involvement was an independent factor both in overall survival （ RR = 1.62, P=0.001） and disease-free survival （RR=1.40, P=0.020）. Conclusions There are more distant metastasis, worse overall survival and disease-free survival in patients with cranial nerve involved. Boost irradiation to the involved skull base may improve the local control. Radiotherapy combined with chemotherapy for these patients may also have brighter future.