手术联合同步放化疗治疗早期鼻咽癌的前瞻性研究

A prospective study of surgery combined with concurrent radiochemotherapy in the treatment of patients with early stage nasopharyngeal carcinoma

目的:探讨手术联合同步放、化疗治疗早期鼻咽癌的疗效。方法:将早期鼻咽癌患者按患者意愿分为手术组(31例)和常规组(73例)。手术组采用手术加同步放、化疗方案治疗,常规组采用同步放、化疗方案治疗。观察指标为:①5年生存率、无瘤生存率;②鼻咽部放射剂量;③口干症的发生率。结果:①总的5年随访率为97.12%,其中手术组失访1例,5年随访率为96.77%;常规组失访2例,5年随访率为97.26%;②104例患者的5年生存率为83.65%(87/104),局部复发率及远处转移率均为9.62%(10/104);③5年生存率和无瘤生存率手术组分别为96.77%(30/31)、93.55%(29/31),常规组分别为78.08%(57/73)、73.97%(54/73),2组比较均差异有统计学意义(均P<0.05);④手术组、常规组鼻咽部放射剂量分别为(63.90±5.56)Gy、(71.48±4.18)Gy,2组比较差异有统计学意义(P<0.05);⑤口干症的发生率手术组为22.58%(7/31),明显低于常规组的65.75%(48/73),2组比较差异有统计学意义(P<0.05)。结论:手术联合放、化疗治疗早期鼻咽癌,既可提高患者远期生存率,又可减少鼻咽部的放射剂量,降低放射并发症的发生,是早期鼻咽癌有效的综合治疗方案,值得进一步研究。

Objective：To investigate the clinical value that surgical treatment with comprehensive treatment in treating early stage nasopharyngeal carcinoma.Method：Based on the case selection criteria,patients with early nasopharyngeal carcinoma were divided into surgery group and the conventional group according to patients＇ wishes.Surgery group were treated with surgery plus Radiochemotherapy as a comprehensive treatment while conventional group were treated with Radiochemotherapy.Outcome indices：①5-year survival rate and 5-year disease-free survival rate;②Radiation dose to the nasopharynx;③Incidence of xerostomia.Result：①The overall 5-year follow-up rate was 97.12%;1 patient was lost to follow-up in surgical group,the 5-year follow-up rate was 96.77%;2 patients were lost in conventional Group with 5-year rate of 97.26%.②The 5-year survival rate of 104 patients was 83.65%（87/104）.③The 5-year survival rate and 5-year tumor-free survival rate were 96.77%（30/31） and 93.55%（29/31） in surgical group,78.08%（57/73） and 73.97%（54/73） in conventional group.There were significant differences between the two groups（P0.05）.④The radiation dose to the nasopharynx in surgery group and conventional group were（63.90±5.56）Gy and（71.48±4.18）Gy,respectively;the dose in surgical group was significantly less than the conventional group,there were statistical significance between the two groups.⑤The incidence of xerostomia was significantly less in surgical group（22.58%） than conventional group（65.75%）,the difference was statistically significant.Conclusion：The surgery combined with concurrent chemoradiotherapy is a effective comprehensive therapeutic interchange program for early stage nasopharyngeal carcinoma.These program can increase the long-term survival rate,but also reduce the radiation dose to the nasopharynx and the occurrence of radiation complications.A further aspect is worth consideration.