鼻咽癌根治性放疗后颈淋巴结残留的手术治疗

Salvage surgery for patients with residual cervical lymph node of nasopharyngeal carcinoma after radical radiotherapy

目的探讨鼻咽癌根治性放疗后单纯颈部淋巴结残留手术的适应证及疗效。方法32例患者根据肿瘤的大小、残留淋巴结活动度及个数行局部肿瘤切除或颈淋巴结清扫术。用SPSS 11．0统计软件包Kaplan-Meier法分析生存率,Log-Rank法行差异显著性检验,Cox模型对影响生存率的有关因素进行分析。结果3年和5年总生存率分别为56．3%和37．5%,单因素分析表明：残留淋巴结大小、淋巴结个数、活动度、放疗结束后3个月内肿瘤消退快慢、淋巴结包膜浸润、术后化疗明显影响预后(P＜0．05)。多因素回归分析表明：残留淋巴结大小(≥2cm),残留淋巴结活动度,放疗结束后3个月内肿瘤消退快慢,淋巴结包膜浸润为影响总生存率的独立预后因素(P＜0．001)。结论鼻咽癌根治性放疗后3个月单纯颈部淋巴结残留可首选手术治疗,术后患者总生存率明显提高。但需掌握手术适应证。残留淋巴结小、淋巴结活动、放疗后3个月内肿瘤消退快,则预后较好,淋巴结包膜浸润者,则术后预后差。

OBJECTIVE To explore the surgical indication and efficacy in patients with simple residual cervical lymph node of nasopharyngeal carcinoma after radical radiotherapy. METHODS The clinical data of 32 patients with simple residual cervical lymph node of nasopharyngeal carcinoma after radical radiotherapy were analyzed retrospectively. The patients had underwent excision alone or radical neck dissection according to the size of the tumor＇ the mobility and the numbers of the residual lymph node. The survival rate was calculated with Kaplan-Meier method in SPSS 11.0 statistical package. The significance of difference was examined by the Log-Rank test. The related factors which influence survival rate were screened by Cox proportional hazards model. RESULTS The overall 3 and 5 year survival rates were 56.3% and 37.5% respectively. Univariate analysis showed that some factors significantly influenced the overall survival rate（P〈0.05）. The factors included size （≥2cm） ＇ number and the mobility of residual lymph node＇ the speed of tumor regression within 3 months after radiotherapy＇ and extracapsular spread. Multivariate analysis also showed that these factors were independently affected overall survival rate（P〈0.001）. CONCLUSION The patients with simple residual cervical lymph node after 3- month radical radiotherapy for nasopharyngeal carcinoma should accept operation chiefly. The operation can improve the survival rate＇ but the indications should be considered. The prognosis is good in the patients with small＇ mobile and rapid regression of tumor within 3 months after radiotherapy. And the prognosis is bad in patients with extracapsular spread of the lymph node.