鼻咽癌2008分期和第7版UICC分期的比较研究

Comparison of 2008 Staging System and the Seventh Edition of UICC Staging System for Nasopharyngeal Carcinoma

目的:通过对鼻咽癌2008分期和第7版UICC分期的比较,探讨其合理性,为2008分期的修订完善提供参考。方法:收集广西医科大学第一附属医院放疗科收治的经病理证实、无远处转移的初诊鼻咽癌患者100例,按各个分期标准中提及的所有解剖结构进行MRI阅片,结合患者就诊时的临床体检资料(如脑神经麻痹、淋巴结大小等),按鼻咽癌两种临床分期标准进行分期。结果:解剖结构定义不同的鼻腔受侵16例(第7版UICC27例)、口咽受侵犯3例(第7版UICC 11例),两种分期中T_1、T_2例数完全相同。T_3、T_4例数有一定差别,这与第7版UICC分期中将鼻窦受侵归为T_3有关。N_0例数完全相同,N_1例数相差最大,未出现淋巴结最大径>6cm的病例,临床总分期基本一致。Ⅲ+Ⅳ期病例分别为97例和95例,晚期病例占绝大多数。结论:两种分期鼻咽和口咽、鼻腔的分界不同,口咽和鼻腔受侵的T分期归属不同,但第7版UICC分期中鼻腔和口咽受侵均全部合并更高期别的T因素,所以未造成两种分期T_1、T_2例数的差别。2008分期中,翼内肌受侵(37%),100%合并同期别和更高期别T因素,故翼内肌的合理性有待研究。2008分期中副鼻窦受侵归为T_4、咽后淋巴结归转移为N_(1a)、N分期采用3cm的标准是合理的。可对RTOG(2006年版)颈部淋巴结影像学分区做适当调整,制定出锁骨上区的影像学边界,以便与UICC分期接轨。两种分期的脑神经受累的MRI诊断标准需要完善。

Objective： To compare the staging system of 2008 Staging System and the seventh edition of UICC staging system for nasopharyngeal carcinoma and to investigate the reasonableness of them, in an effort of providing references for improvement of 2008 staging system. Methods： A total of 100 patients pathologically confirmed with nasopharyngeal carcinoma without distant metastasis were collected. Based on MRI and clinical features, these patients were staged with the two staging systems. Results： Sixteen patients had involvement in the nasal cavity （ 27 cases according to the seventh edition of UICC staging system ）. Three cases had involvement in the oropharynx （ 11 cases according to the seventh edition of UICC staging system）. No difference was found in the number of T1 cases and T2 cases between the two staging systems. The number of T3 cases and T4 cases was different, due to the classification of sinus involvement as T3 in the seventh edition of UICC. The number of No cases was exactly the same according to both of the staging systems. The difference in the number of N1 cases between the two systems was the biggest. There were no cases with lymph nodes of more than 6cm in the maximum diameter. with the total clinical stage. There were 97 Ⅲ cases and 95 The staging results with the two staging systems was almost consistent Ⅳ cases, with advanced cases as the vast majority. Conclusion： The boundaries of the nasopharynx, oropharynx and nasal cavity are different in the two staging systems. And between the two staging systems, the T staging is different when the nasal and oropharyngeal are involved. But in the seventh edition of UICC staging system, the nasal and oropharyngeal involvement are accompanied with other factors associated with higher T stage, resulting in no difference in the number of T1 cases and T2 cases. In 2008 staging system, the incidence of pterygoid muscle involvement was 37% （ 37/100 ）, 100% combined with other T factors of the same stage or higher stage. The value of assessing pterygoid muscle involvement needs further investigation. In 2008 staging system, the classification of paranasal .sinus involvement as T4, retropharyngeal lymph node metastasis as N1a, and N staging with 3cm standard are reasonable. Adjustment can be made in the imaging area of cervical lymph nodes in RTOG （2006） and the imaging boundaries of the supraclavicular area should be identified in order to integrate with the UICC staging. The standards for MR/diagnosis in both of the two systems need further improvement.