148例鼻咽癌肝转移的治疗与预后分析

Treatment and prognosis analysis of 148 nasopharyngeal carcinoma cases with liver metastasis

目的探讨鼻咽癌肝转移的临床特点、治疗效果及预后因素。方法采用SPSS13．0统计软件回顾性分析148例鼻咽癌肝转移患者的临床特点、治疗、生存及预后因素。结果全组中位无病生存期（DFS）8．5个月（0—247个月），肝转移后的中位生存期7个月（1—76个月），1、2和3年生存率分别为24．3％、6．6％和2．6％。未治组、化疗组与放化疗组生存差异有显著的统计学意义（P=0．000），中位生存期分别为3、8和18．5个月。〉4疗程化疗较无治疗和≤4疗程化疗者死亡风险分别下降63％和31％。多因素分析显示年龄、DFS、初治即转移、肝转移的数目及转移后的治疗为影响预后的重要因素。结论鼻咽癌肝转移预后不良，须根据病情作合理的个体化治疗。对于非高龄（≤60岁）、肝功能无明显异常和无腹水的患者，争取行多疗程化疗（〉4疗程）及综合放射治疗，可提高肝转移的生存期。

Objective To detect the clinical characteristics,treatment results and prognosis factors of nasopharyngeal carcinoma（NPC） with liver metastasis. Method We had collected 148 patients who were diagnosed as NPC and were detected as liver metastasis. Their clinical characteristics, treatment efficacy and prognosis factors were analyzed retrospectively by using SPSS 13.0 statistic software. Result To all patients, the median disease -free survival（DFS） was 8.5 months（ range ：0 -247 months）, the median survival after detected as liver metastasis was 7 months（ range： 1 - 76 months）, 1,2,3 years survival rate was 24.3% ,6.6% and 2.6% respectively. There were distinguished statistic difference in survival among the untreated group, chemotherapy group and chemo - radiotherapy group（P =0. 000） ,the median survival of them was 3,8 and 18.5 months respectively. The death risk for patients who had got more than 4 cycles chemotherapy decreased 63% and 31% respectively,compared to untreated patients and those got loss than 4 cycles chemotherapy. Multivariate analysis showed age, DFS, metastasis in initial diagnosis,liver metastasis lesions number, treatment were the important prognosis factors. Conclusion The prognosis of NPC with liver metastasis was very poor. This kind of patient should take individualized treatment. Multiply cycles of chemotherapy（ more than 4 cycles）or chemo combined radiation therapy might be benefit for patients who were younger than 60,with normal liver function and without ascitos.