非转移性T4期鼻咽癌的预后影响因素分析

Multivariate Analysis of Prognostic Factors for Stage T4 Non-metastatic Nasopharyngeal Carcinoma

目的探讨非转移性ⅣA期鼻咽癌的预后影响因子。方法初治的T4N0～3 M0(UICC1997版分期)鼻咽癌患者145例纳入临床研究,分析患者的复发、转移、生存情况及预后影响因素。结果 145例患者的5年OS、CCS、PFS、DLRFS、DMFS分别为59.2%、61.3%、53.0%、71.6%、62.6%。多因素分析显示:颈动脉鞘区受侵是影响DLRFS、DMFS的不良预后因素,UICC N分期是影响DLRFS、DMFS的独立预后因素;颈动脉鞘区受侵是影响CCS的独立不良预后因素,年龄、颈部照射剂量、UICC N分期是影响CCS的独立预后因素。单因素分析显示:颈动脉鞘区受侵、UICC N分期是影响CCS、PFS的预后因素,同期化疗或放疗联合化疗虽提示有提高DMFS及提高CCS的趋势,但差异无统计学意义(P>0.05)。结论颈动脉鞘区受侵、UICC N分期是影响非转移性T4期鼻咽癌的重要预后因子。

Objective To investigate prognostic factors for stage Ⅳa nasopharyngeal carcinoma.Methods From January 1,2003 to December 12,2004,145 patients with stage T4N0～3M0（UICC1997 staging criteria） nasopharyngeal carcinoma without prior treatment were recruited in this trial.The recurrence,metastasis,survival and prognostic factors were analyzed.Results 5-year overall survival（OS） rate,5-year cancer correlated survival（CCS） rate,5-year progression-free survival PFS） rate,5-year disease locoregional recurrence-free survival（DLRFS） rate and 5-year distant metastasis-free survival（DMFS） rate was 59.2%,61.3%,53.0%,71.6% and 62.6%,respectively.Multivariate analysis showed： carotid sheath invasion was a poor prognostic factor affecting LRFS and DMFS,UICC N staging was an independent prognostic factor affecting LRFS and DMFS;carotid sheath invasion was an independent poor prognostic factor affecting CCS,age,neck exposure dose and UICC N staging were independent prognostic factors affecting CCS.Univariate analysis showed： carotid sheath invasion and UICC N staging were prognostic factors affecting CCS and PFS,although concurrent chemotherapy or radiotherapy in combination with chemotherapy resulted in the trend of improving DMFS and CCS,there was no statistically significant difference（P0.05）.Conclusion Carotid sheath invasion and UICC N staging were important prognostic factors for stage T4 non-metastatic nasopharyngeal carcinoma.