鼻咽腺癌的临床病理特征和预后

Clinicopathological features and prognosis of nasopharyngeal adenocarcinoma

目的研究鼻咽腺癌的临床特点，EB病毒血清学和治疗效果。方法回顾性研究中山大学肿瘤防治中心1964至2000年诊断为鼻咽腺癌患者的临床资料。结果48例鼻咽腺癌患者中，45．2％出现颈部淋巴转移（包括7例N1，8例N2及4例N3期患者）。病理分型可见普通型腺癌和涎腺型腺癌分别占58．3％（28例）和41．7％（20例）。EB病毒抗体VCA—IgA的总体阳性率为56．7％（17／30），在涎腺型鼻咽腺癌患者中仅为27．3％（3／11）。治疗后总体的局部控制率为87．0％（40／46），Kaplan—Meier法统计5年无瘤生存率为65．2％。手术＋放疗组和单纯放疗组的年龄、性别、N和M分期组间差异无统计学意义，但组间T分期不均衡（X^2=4．801，P=0．045）。接受手术加放疗的8例患者较单纯放疗的31例患者5年无瘤生存率为高（分别为88．9％和74．7％，Logrank检验：）（X^2=4．272，P=0．039）。Cox多因素分析表明，治疗方式和肿瘤N分期是影响生存的显著因素（相对危险度RR值分别为15．276和6．529，P值均〈0．05）。结论鼻咽腺癌在各种鼻咽癌类型中具有独特性，EB病毒血清学对鼻咽腺癌的诊断有局限性。对于早期的鼻咽腺癌患者，手术加放疗可能是另一种有效的治疗方式。

Objective To investigate the clinical manifestations, EB virus serology and treatment outcome of nasopharyngeal adenocarcinoma （NPAC）. Methods Clinical records of NPAC patients between 1964 and 2000 in Cancer Center of SUN Yat-sen University were retrospectively reviewed. Results Among 48 patients with NPAC, 45.2% （7 cases of N1,8 cases of N2 and 4 cases of N3） of them presented with cervical metastasis. Pathologically, common type and salivary gland type of NPAC accounted for 58. 3% （28 cases） and 41.7% （20 cases） respectively. The positive rate of the EB virus antibody VCA-IgA was 56. 7% in the whole group and only 23.7% in the salivary gland type of NPAC. The overall local control rate and the 5-year disease free survival rate by Kaplan-Meier method were 87.0% （40/46） and 65.2% respectively. Baseline data analysis showed that age, gender, N stage and M stage were not the significant factors, never the less the T stage was not balanced between the two groups （ surgery plus radiotherapy vs radiotherapy alone, X^2 = 4. 801, P = 0. 045 ） . The patients treated by surgery plus radiotherapy had significantly higher 5-year disease free survival rate than by radiotherapy alone （ 88. 9% vs 74. 7%, Log Rank test ： X^2 = 4. 272, P = 0. 039）. Cox＇ s multivariate analysis showed treatment modality and N stage were the significant factors influencing survival （ RR were 15.276 and 6. 529, P 〈 0. 05 ）. Conclusions NPAC is a distinct entity in all types of nasopharyngeal carcinoma- EB virus serology has limited value in its diagnosis. Surgery plus radiotherapy could be another choice of treatment for early lesions of NPAC.