鼻咽癌放疗后第二原发舌鳞癌35例

Clinical analysis of 35 cases second primary tongue squamous cell carcinoma after nasopharyngeal carcinoma radiotherapy

目的 探讨鼻咽癌放疗后第二原发舌鳞癌的临床特点、有效的治疗手段、生存情况和影响预后的因素.方法 回顾性分析35例鼻咽癌放疗后第二原发舌鳞癌患者的临床和随访资料,应用Kaplan-Meier法及Log-Rank检验、COX回归模型等对本组病例资料进行统计分析.结果 35例患者总的3、5年生存率分别为55%、47%,淋巴结转移率为5.71%;单因素分析提示性别（χ2=8.89,P：0.00）、T分级（χ2=5.58,P=0.02）、临床分期（χ2=8.51,P=0.04）、治疗方法（χ2=29.37,P=0.00）是影响预后的重要因素;多因素分析显示治疗方法（P=0.00）、T分级（P=0.03）是与预后有关的重要独立因素;手术治疗组较非手术治疗组预后好,差异有统计学意义（P〈0.05）;男性患者发生第二原发舌鳞癌的风险较女性患者高;第二原发舌鳞癌随鼻咽癌放疗后时间的延长发病率升高.结论 鼻咽癌放疗后第二原发舌鳞癌淋巴转移率较低;治疗方法和T分期是影响预后的独立凶素;鼻咽癌放疗后需长期随访,早期诊断第二原发舌鳞癌,并给予手术或包含手术的综合治疗,以取得好的疗效.

Objective To investigate the clinical features, effective treatment, survival and prognostic factors of second primary tongue squamous cell carcinoma （SPTSCC） after nasopharyngeal carcinoma （NPC） radiotherapy. Methods The clinical data of 35 cases with SPTSCC after NPC radiotherapy were analyzed retrospectively. Kaplan-Meier method, Log-Rank test and COX proportional hazard mode was performed for statistical analysis. Results 3-year and 5-year overall survival rates were 55 % and 47 %, respectively, lymph node metastasis rate was 5.71 %. Univariate analysis indicated that gender （χ2 = 8.89, P = 0.00）, T classification （χ2= 5.58, P= 0.02）, clinical stage （χ2 = 8.51, P= 0.04） and treatment methods （χ2 = 29.37, P = 0.00） were important factors of prognosis. Multivariate analysis showed that treatment methods （P = 0.00） and T classification （P = 0.03） were independent prognostic factors. Operative treatment group had better prognosis than the non-operative treatment group, the difference was statistically significant （P 〈0.05）, male patients in the risk of SPTSCC was higher than the female patients, and the incidence of SPTSCC was increased along with extension of the time after NPC radiotherapy. Conclusion The rate of the lymph node metastasis is lower for SPTSCC after NPC radiotherapy and treatment patterns and T stage are independent prognostic factors. Long-term follow-up after NPC radiotherapy is necessary to the early diagnosis of SPTSCC, so that to give surgery or combined therapy with surgery in order to achieve a good effect.