46例首诊伴远处转移鼻咽癌的预后分析

Therapeutic results of 46 patients with initially diagnosed metastatic nasopharyngeal carcinoma

目的回顾性分析初诊时即伴有远处转移的鼻咽癌患者的治疗结果并探讨其预后。方法3年余共收治46例初诊伴有远处转移的鼻咽癌患者，其中43例为单器官转移，3例为多器官转移。肝转移19例，骨转移11例，肺转移7例，腋窝淋巴结和纵隔淋巴结各6例，脑转移1例。所有患者均接受了鼻咽部及颈部40～85Gy放疗。41例接受了1—5周期PF方案化疗，23例接受了远处转移灶姑息性放疗。结果随访率为100％。1、2、3、5年生存率分别为66％、47％、30％、19％，中位生存时间为20个月。转移灶是否放疗及KPS评分是影响生存的预后因素。转移灶放疗与未放疗的中位生存时间分别为39个月和13个月（χ^2=8．63，P=0．012），KPS评分≥80和〈80的中位生存时间分别为26个月和12个月（χ^2=3．95，P=0．035）。结论首诊远处转移的鼻咽癌患者得到积极治疗后仍有长期生存可能，KPS评分高者预后好，在全身化疗、原发灶放疗及支持治疗的同时转移病灶局部治疗可能延长生存时间。

Objective 3＇o retrospectively analyze the therapeutic results of patients with initially diagnosed metastatic nasopharyngeal carcinoma （NPC）. Methods From January 1995 to December 1998, 46 NPC patients with distant metastases were treated in Fujian provincial cancer hospital. Among these patients, 43 were single site metastasis and 3 were multiple sites metastases ;The site of metastasis were 19 patients in the liver, 11 in the bone, 7 in the lung, 1 in the brain, 6 in mediastinal nodes and 6 in axillary lymph nodes. All patients received standard radiotherapy to the primary site and cervical node region with a median dose of 72 Gy. Forty-one patients （89%） received 1 -5 cycles chemotherapy （eisplatin and 5-flu- orouraeil ）, and 23 （50%） received palliative irradiation to the metastatic site. Results The median survival time was 20 months. The 1-, 2-, 3-year and 5-year overall suvival rates were 66% , 47% , 30% and 19% , respectively. Irradiation to the metastatic sites and KPS were the significant prognostic factors. Patients with palliative irradiation to the metastatic site had longer survival than those without （ 39 months vs. 13 months, χ^2 = 8.63, P = 0.012）. Patients with good performance status （ KPS ≥ 80） had better outcomes thanthose with poor performance status （ 2 6 months vs. 1 2 months ,χ^2 = 3.95 , P = 0. 035 ） . Conclusions Active therapy may prolong the survival of patients with initially diagnosed metastatic NPC, especially for those who have good performance status. Under systematic chemotherapy, radiotherapy to the primary site and supportive care, the palliative irradiation to the metastatic site may also yield a good result.