影响鼻咽癌颈淋巴结复发多因素分析

Multivariate analysis of cervical lymph node recurrence of nasopharyngeal carcinoma after radiotherapy

目的 探讨鼻咽癌放疗后颈淋巴结复发的原因。方法 １９８７ 年１ 月～１９９２ 年１２ 月首次治疗鼻咽癌３２１ 例，颈部用６０Ｃｏ 加深部Ｘ线照射，ＤＴ５２～７８ Ｇｙ／４０～８８ ｄ。应用ＫａｐｌａｎＭｉｅｒｅ 方法和ＣＯＸ模型对放疗后３ 年颈部局控率及影响局部复发因素作分析和评价。结果 ３ 年颈淋巴结复发率１５％ ，多因素ＣＯＸ模型显示影响局控率的有Ｎ分期、总疗程时间、生物有效剂量（ＢＥＤ）、化疗和肿瘤残留。在Ｎ１～２ 中总疗程时间≤６５ 天与＞６５ 天的３ 年局控率分别为８７％ 、６１％（ Ｐ＝０．００２），ＢＥＤ≤５９ Ｇｙ 与＞ ５９ Ｇｙ 的３ 年局控率分别为７８％ 、９２％ （ Ｐ＝０ ．０１６）。结论 ＢＥＤ越大，局控率越高；疗程延长，局控率下降，据此提出改进常规鼻咽癌颈部放疗方法。

Objective To study factors related to cervical lymph node recurrence of nasopharyngeal carcinoma after radiotherapy.Methods 321 cases of nasopharyngeal carcinoma from Jan.1987 to Dec.1992 were collected,most of them were treatedwith conventional 60 Co plus deep X ray irradiation.The radiation dose was 52～78 Gy/40～88 days,the 3 year local control rate was estimated with the Kaplan Miere method.COX model was also performed to adjust relapse factors.Results The 3 year neck recurrence rate was 15%.Multivariate COX model analysis showed that N classification, overall treatment time, biological effective dose(BED), chemotherapy and residual tumour were significant factors in local relapse.In N 1～2 stage patients,the 3 year local control rates for BED≤59 Gy and >59 Gy were 78%,92%,respectively( P= 0.016).Overall treatment time≤65 days and that >65 days were 87%,61%,respectively( P= 0.002).Conclusion The lower BED and the longer overall treatment time are the independent recurrence factors.\;