鼻咽癌临床研究:结果总结与问题的提出

Clinical study on nasopharyngeal carcinoma:8 years experience

总结8年来对1，322例鼻咽癌病人的临床研究结果。病人发病的年龄特点与广东鼻咽癌高发区相同。205例病人有癌家族史，其中92倒有鼻咽癌家族史，先征者与其血缘亲属中的鼻咽癌患者发病年龄有很高的一致性，相关分析r＝0．73，P＜0．001。光导纤维镜检查发现鼻咽癌的鼻腔侵犯有两个类型：粘膜浸润型和游离突入型，两型的放疗反应不同，前者放疗后的近期肿瘤消失率低，远期复发率高。总结随访5年以上者，放疗后5年生存率45．6％。死亡原因局部失败占30．2％，远处转移占60．5％。外照射加近距离照射在解决局部残留和复发方面的效果令人鼓舞，疗后病灶完全消退率达73～79％。前瞻性随机实验提示，放疗过程同时全县化疗则可显著降低N晚期病人的远处转移率，提高生存率。N2和N3病人放＋化疗组5年生存率56．8％，单纯放疗组为30．8％（P＝0．04）。结果为研究本地区鼻咽癌的病因学和监测鼻咽癌高危人群提供了研究线索。针对鼻咽癌放疗失败的主要原因，提出进一步研究预后因素，进一步研究降低局部失败率和远处转移率的治疗方法．是提高鼻咽癌治愈率的主要途径。

From March 1989 through March 1997, 1322 cases of pathologically proven nasopharyngeal carcinoma (NPC) were treated. The age distribution was quite similar compared with that in high NPC mortality district, such as Pearl River Delta. 92 patients had family history of NPC. Comparing the ages at tumor detection, there was a close consistency with probands and NPC patients in their consanguinities(r=0.73, P<0．001). Under endoscope we found that the nasal invasion of NPC can be divided into two types: infiltrative and protuberant, which is of prognostic significance. The proturd type gave better short－term and long－term local control. For those who have been followed up for more than 5 years,the 5 year survival rate was 45.6% The mean causes of death were local failure (30.2%) and distant metastases (60．5%). From clinical trial we found that external irradiation pluse brachytherapy was effective in treating local residual or recurrent disease. Prospective randomized study suggested that concomitant radiotherapy and chemotherapy significantly reduced distant metastases and improved longterm survival for N2 and N3 patients.