840例鼻咽癌预后的多因素分析

Multivariate Logistic Regression Analysis of the Prognostic Factors for 840 Patients with Nasopharyngeal Carcinoma

目的:探讨鼻咽癌放射治疗预后的影响因素,为规范鼻咽癌放射治疗提供参考。方法:对1996年1月至2001年摘1要2月目在的本:院探接讨受鼻放咽疗癌的放8射40治例疗鼻预咽后癌的病影例响进因行素回,顾为性规分范析鼻。咽癌采放用射Ka治pl疗an-提M供eie参r法考计。算方鼻法咽:对局1部99控6年制1率月、无至瘤生存率及总生存率,差别显著性检验采用Log-rank法,Cox回归模型分析影响预后的因素。结果:1)全组3、5、105年8.鼻6%咽和局3部9.4控%制;2率)单分因别素为分70析.6结%、果56显.7示%和性3别6.、6年%龄,无、临瘤床生分存期率分、T别分为期6、6N.8分%期、5、1有.8%无和颅3底2.侵0%犯,总、有生无存颅率神分经别侵为犯73、.有8%无、副鼻窦侵犯、有无颈部淋巴结转移、单侧/双侧颈部淋巴结转移、颈部转移淋巴结的部位、鼻咽腔内后装近距离治疗、外0.0照5)射,鼻分咽割部方照式射、剂有量无对化鼻疗咽等局因部素控对制鼻率咽、局总部生控存制率的率影、无响瘤有生显存著率性及差总异(生P存<0率.05的),影颈响动有脉显鞘著区性侵差犯异者(无P=瘤0生.00存或率<低于无侵犯者(P<0.05),但不影响鼻咽局部控制率及总生存率(P>0.05);3)多因素分析结果显示性别、年龄、临床分期、T分期、单侧/双侧颈部淋巴结转移、鼻咽腔内后装近距离治疗是影响鼻咽部局部控制率、无瘤生存率及总生存率的独立预后因素;4)分层分析结果显示T2～T3期辅助高剂量率腔内后装近距离治疗的患者鼻咽局部控制率、无瘤生存率及总生存率均显著高于不加腔内治疗者(P<0.01～0.05),而T1、T4期患者外照射后加用高剂量率腔内后装近距离治疗并未提高其鼻咽局部控制率、无瘤生存率及总生存率(P>0.05)。结论:鼻咽癌临床分期(特别是T分期)晚期和/或双侧颈部淋巴结转移和/或男性患者预后不佳,在外照射的基础上加用鼻咽腔内后装放疗可改善T2～T3期患者的预后。

Objective： To investigate the prognostic factors for patients with nasopharyngeal carcinoma （NPC） who received radiotherapy （RT） and to provide information about improvement in NPC RT techniques. Methods： We retrospectively analyzed the data from 840 cases of NPC that received RT from January 1996 to December 2001 in our hospital. The Kaplan-Meier method was used to calculate the control rate of nasopharynx, the tumor-free survival rate and overall survival. Log-rank test was conducted to determine significance. The Cox proportional hazards regression model was used to confirm the significance of prognostic factors. Results： 1） The total control rates of nasopharynx for 3, 5 and 10 years were 70.6%, 56.7% and 36.6%, respectively. The tumor-free survival rates for 3, 5, and 10 years were 66.8%, 51.8% and 32.0%, respectively. The overall survival rates for 3, 5, and 10 years were 73.8%, 58.6% and 39.4%, respectively. 2） Univariate logistic regression analysis showed that gender, age, clinical stage, T stage, N stage, skull base invasion, cranial nerve invasion, nasal cavity invasion, cervical node metastasis, unilateral/bilateral neck node metastasis, cervical node metastasis position, intracavity brachytherapy of nasopharynx, external beam radiotherapy method and chemotherapy were significantly associated with the control rate of nasopharynx, tumor-free survival, and overall survival （P〈0.05）. The irradiation dose of nasopharynx was significantly associated with the nasoDharynx control rate and overall survival （P〈0.05）. The tumor-free survival of the patients with carotid sheath involvement was low-er than that of the patients without carotid sheath involvement （P〈0.05）. 3） Multivariate logistic regression analysis showed that gender, age, clinical stage, T stage, unilateral/bilateral cervical node metastasis, and intracavity brachytherapy of nasopharynx were independent influential factors of the control rate of nasophar- ynx, tumor-free survival and overall survival. 4） The stratified analysis showed that T2 and T3 patients who received adjuvant high dose intracavity brachytherapy of nasopharynx presented with a higher control rate of nasopharynx, tumor-free survival and overall survival （P〈0.05）. Conclusion： Male NPC patients with advanced clinical stage （especially T stage） and bilateral cervical node metastasis have a poorer prognosis. Adjuvant in- tracavity brachytherapy of nasopharynx can improve the prognosis of T2 and T3 patients.