鼻咽癌茎突后间隙侵犯的临床意义探讨

THE CLINICAL SIGNIFICANCE OF POSTSTYLOID SPACE EXTENSION IN NASOPHARYNGEAL CARCINOMA

目的探讨鼻咽癌茎突后间隙侵犯的临床意义。方法１９８例Ｉ～Ⅳａ期鼻咽癌住院初治患者接受根治放疗。按茎突后间隙有无侵犯分为茎后侵犯组和茎后无侵犯组。应用Ｋａｐｌａｎ－Ｍｅｉｅｒ，Ｌｏｇ－Ｒａｎｋ及卡方检验等方法对两组病人５ａ生存率、局控率和无远处转移生存率进行分析和评价。结果两组５ａ生存率分别为４６．７６％和６８．８８％（Ｐ＝０．００２７），两组无远处转移生存率分别为７１．６８％和８４．２２％（Ｐ＝０．０４６８）。结果表明茎突后间隙侵犯者生存率和局控率降低，远处转移增多。结论茎突后间隙的侵犯是影响预后的重要因素之一，在分期上将之划归Ｔ３是合理的；在鼻咽癌放射治疗设计中，鼻咽、咽旁特别是茎突后间隙、颅底、上颈淋巴结引流区应设置在同一靶区内。

Objective To approach the clinical significance of poststyloid space extension nasopharyngcal carcinoma.Methods One hundred and ninety eight patients with newly treated nasopharyngeal carcinoma(stage I～Ⅳa) were analyzed. These patients were divided into two groups depending on the poststyloid space being invaded or not. The 5 year survival rate, relapse free and distant metastasis free after the treatment were estimated using the Kaplan Meier, Log Rank methods.Results The 5 year survival rates were 46.76% and 68.88% respectively (P=0.0027).The survival rates in those without distant metastasis were 71.68% 84.22% respectively (P=0.0468).These results showed that the survival rate and the local control rate were reduced and the distant metastasis was increased in paticnts with poststyloid space extension.Conclusions The poststyloid space extension was an important prognostic factor of poor treatment outcome.It was reasonable that it being classified as stage T 3. The nasopharyx, paranasopharyngeal space (especially for poststyloid space), the base of the skull and the areas of the deep upper cervical lymph nodes should be included in the same field in radiotherapy for patients with nasopharyngeal carcinoma.