鼻咽癌三叉神经侵犯的MRI评价及预后价值

Impact of MRI-evidenced Trigeminal Nerve Involvement on the Prognosis of Nasopharyngeal Carcinoma

目的:应用MRI评价鼻咽癌三叉神经侵犯,并分析其预后价值。方法:连续收集经病理证实的初治及无远处转移的鼻咽癌患者共924例。所有病例行鼻咽部和颈部MRI扫描。结果:MRI三叉神经侵犯为315例(34.1%)。MRI三叉神经侵犯而无三叉神经麻痹的患者占MRI三叉神经侵犯总病例数的85.4%。在88条发生麻痹的三叉神经分支中,79条(89.8%)发现MRI显示相应的三叉神经颅内或眼眶段受侵。T3患者MRI三叉神经侵犯阳性组较MRI三叉神经侵犯阴性组的3年总生存率(OS)明显降低(80.0%:88.1%,P=0.016),经N分期调整后,两组3年OS的差异仍具有统计学意义(P=0.023)。多因素分析显示:影响鼻咽癌T3患者OS的独立预后因子分别为MRI三叉颅神经侵犯(P=0.035)及N分期(P=0.000)。MRI三叉神经侵犯阳性的患者中,三叉神经颅内或眼眶段侵犯组与三叉神经颅外或颅底段侵犯组3年OS、无远处转移生存率(FDMS)及无局部复发生存率(LRFS)无差别(P=0.672,P=0.993,P=0.672),三叉神经麻痹组较无三叉神经麻痹组3年OS、FDMS及LRFS亦无差别(P=0.707,P=0.283,P=0.542)。结论:鼻咽癌MRI三叉神经侵犯发生率较高。三叉神经颅内或眼眶段侵犯是导致三叉神经麻痹的主要原因。MRI对显示三叉神经侵犯的定位更精确,并可应用于判断鼻咽癌患者的预后。

Objective： To study the MR images of trigeminal nerve involvement in nasopharyngeal carcinoma （NPC） and its impact on prognosis. Methods： A total of 924 consecutive patients with newly diagnosed nonmetastatic NPC who had undergone MRI scan of nasopharynx and neck were collected. The MR images and the medical records were reviewed retrospectively. Results： MRI-evidenced trigeminal nerve involvement was found in 315 （34.1%） patients, in which the percentage of patients without trigeminal nerve palsy was 85.4%. In 88 branches of trigeminal nerve palsy, 79 branches （89.8%） were detected with corresponding intracranial or orbital trigeminal nerve involvement. In T3 disease, MRI-evidenced trigeminal nerve involvement was associated with poor 3-year overall survival （OS） rates, 80.0% vs. 88.1%（P= 0.016）. In patients with MRI-evidenced trigeminal nerve involvement, no significant differences were observed in the 3- year OS, distant metastasis-free survival（DMFS） and local relapse-free survival（LRFS）（P=0.672, 0.993 and 0.672, respectively） between patients with and without intracranial or orbital trigeminal nerve involvement. Furthermore, no significant differences were found in the 3-year OS, DMFS and LRFS （P=0.707, P=0.283 and P=-0.542, respectively） between symptomatic and asymptomatic patients. Conclusion： The rate of MRI-evidenced trigeminal nerve involvement is high in nasopharyngeal carcinoma. The main reason for trigeminal nerves palsy was intracranial or orbital trigeminal nerve involvement. MRI was precise in diagnosing the location of trigeminal nerve involvement and can be used to determine the prognosis of NPC.