鼻咽癌颈椎破坏的临床特征及预后分析

Clinical Features and Prognosis of Nasopharyngeal Carcinoma with Cervical Vertebra Damage

目的分析鼻咽癌颈椎破坏的临床特点、治疗方法和预后,并探讨临床治疗策略的合理性。方法收集42例初次治疗中仅有颈椎破坏的鼻咽癌。根据MRI、PET-CT或CT加骨扫描的结果为：颈椎侵犯的鼻咽癌T4M0期（20例）和仅有颈椎转移的鼻咽癌M1（22例）。回顾性分析比较两者PFS及OS差异的显著性,并单因素生存分析其临床特点、治疗模式与预后的关系。结果中位随访时间为19个月（3~38个月）,中位总生存时间为15个月,24例死亡,16例存活,失访2例,两组患者2年总生存率分别为57.1%和36.4%（P=0.173）,无疾病进展生存率为42.9%和27.3%（P=0.361）。单因素分析结果得出,对颈椎有破坏的T4M0期鼻咽癌患者,治疗方式、近期疗效、EBV病毒数量及失败模式是其独立预后因素。对仅有颈椎转移的M1期鼻咽癌患者,HBG、PLT、ZPS评分及失败模式是其独立预后因素。结论不同分期（T4M0、M1）颈椎破坏的鼻咽癌者,2年OS总生存率及PFS无疾病进展生存率无显著性差异,但临床治疗近期疗效较好。颈椎有侵犯的T4M0期鼻咽癌患者,治疗方式、近期疗效、EBV病毒数量、失败模式可能是其独立预后因素。仅有颈椎转移M1期鼻咽癌患者,HBG、PLT、ZPS评分及失败模式可能是其独立预后因素。

Objective To investigate the clinical features,treatment strategies and the prognosis of nasopharyngeal carcinoma with cervical vertebra damage.Methods Data of 42 newly diagnosed nasopharyngeal carcinomas with cervical vertebra damage were analyzed.The patients were divided into 2 groups according to the results of the MRI,PET-CT,CT and ECT：20 patients had cervical vertebra involvement directly from the primary tumors,and 22 had metastatic diseases.The PFS and OS in the 2 groups were analyzed,and univariate analysis of the prognosis was performed.Results After a median follow-up of 19 months,24 patients were died,16 were alive,and 2 lost to follow-up.The median survival time for all patients was 15 months.The 2 year overall survival for the 2 groups was 58% and 38%（P=0.173）,and the progression-free survival was 42.9% and 27.3%（P=0.361）.For patients with direct involvement from the primary tumor,treatment strategies,the short-term treatment effect,EBV quantities and type of failure were prognostic factors in the univariate analysis.For those with cervical vertebrae metastases,HBG,PLT,ZPS marks and type of failure were prognostic factors.Conclusion There is no significant difference in the 2 year survival rate between the patients with direct involvement from primary nasopharyngeal carcinoma or those with cervical vertebra metastases.However,the prognostic factors in the two groups are different.