1706例鼻咽癌放疗远期疗效分析

Long-term results of nasopharyngeal carcinoma treated with radiotherapy： 1706 cases report

目的分析20世纪末笔者医院鼻咽癌放疗的远期疗效、影响预后的因素以及后遗症。方法对1995年1月1日至1998年12月31日期间收治的1706例鼻咽癌初治患者做回顾性分析，其中单纯放疗1081例，氟尿嘧啶、顺铂新辅助化疗加放疗625例。放疗配合热疗23例，外照射加^192Ir后装治疗162例。结果全组患者5年总生存率、局部控制率和无瘤生存率分别为67．60％、84．20％和64．22％；Ⅰ、Ⅱ、Ⅲ、Ⅳ期5年生存率分别为100％、75．93％、66．47％、49．34％。Cox多因素回归分析显示生存率与T分期、N分期、M分期、临床分期、放疗是否中断、化疗、性别、年龄和放疗前是否贫血有关；与治疗结束时鼻咽或（和）颈淋巴结残留、鼻咽照射剂量、射野方式、是否后装治疗、高血压和糖尿病无关。结论临床分期早、发病年龄小、女性、放疗前无贫血、疗程顺利和配合化疗者是鼻咽癌放疗后获得长期生存的主要因素。

Objective To analyze the long-term efficacy,prognostic factors and radiation sequela of nasopharyngeal carcinoma （NPC） treated with radiotherapy at the end of last century. Methods From January 1995 to December 1998,1706 newly diagnosed NPC patients treated with radiotherapy were included in the retrospective clinical analysis. There were 1081 patients treated with radiotherapy alone,625 with two to three circles of chemotherapy（ 5-Fu and DDP） before radiotherapy,23 with thermotherapy during radiotherapy and 162 with brachytherapy by ^192Ir after external beam radiation. Results The 5-year overall survival, local control survival and disease-free survival rates were 67.60% ,84.20% and 64.22% ,respectively. The 5-year survival of patients with stage Ⅰ , Ⅱ,Ⅲ and Ⅳ （the Fuzhou Staging, 1992） were 100% ,75.93%, 66.47% and 49.34% , respectively. Cox regression analysis showed that the TNM classification, radiotherapy discontinuance, chemotherapy, sex, age and anemia before radiotherapy were the significant factors of survival. Conclusions Our experience shows that the main factors for the long term survival of NPC patients after radiotherapy are early TNM stage, young age, female, non-anemia before radiotherapy, radiotherapy continuance and chemotherapy.