鼻咽癌茎突后间隙侵犯的临床意义探讨

The clinical significance of poststyloid space extension in nasopharyngeal carcinoma

目的 探讨鼻咽癌茎突后间隙侵犯的临床意义。方法 1992年 12月～ 1993年 12月198例I IVa期鼻咽癌住院初治患者接受根治性放射治疗。按茎突后间隙有无侵犯分为茎后侵犯组和茎后无侵犯组。应用Kaplan Meier,Log Rank及卡方检验等方法对两组患者 5年生存率、局部控制率和无远处转移生存率进行分析和评价。结果 两组患者口咽侵犯率分别为 72 1%和 16 8% (P <0 0 0 1) ,后组颅神经侵犯率分别为 2 0 9%和 6 2 % (P <0 0 1) ,颈淋巴结转移率分别为 6 9 8%和 35 4%(P <0 0 1) ;两组 5年生存率分别为 46 8%和 6 8 9% (P =0 0 0 2 7) ,两组局部控制率分别为 6 3 7%和78 7% (P =0 0 86 2 ) ,两组无远处转移生存率分别为 71 7%和 84 2 % (P =0 0 46 8)。结果表明茎突后间隙侵犯者生存率和局部控制率降低 ,远处转移增多。结论 茎突后间隙的侵犯是影响预后的重要因素之一 ,在分期上将之划归T3

Objective To explore the clinical significance of poststyloid space extension in nasopharyngeal carcinoma Methods One hundred and ninety eight patients with newly treated nasopharyngeal carcinoma (stageⅠ～Ⅳa) were analyzed These patients were divided into two groups depending on whether the poststyloid space was extended or normal The 5 year survival rate, relapse and distant metastasis after the treatment were estimated using the Kaplan Meier, Log Rank methods Results The rates of patients with oropharyngeal extension for these two groups were 72 1% and 16 8% respectively ( P <0 001) The rates of the cases with involvement of the 9,10,11,12 th cranial nerves were 20 9% and 6 2% respectively ( P <0 01) The rates of metastasis to cervical lymph node were 69 8% and 35 4% respectively ( P <0 01) The 5 year survival rates were 46 76% and 68 88% respectively ( P =0 002 7) The local control rates were 63 7%, 78 7% respectively ( P =0 086 2) The distant metastasis free survival rates were 71 7% and 84 2% respectively ( P =0 046 8) These results showed that the survival rate, the local control rate were reduced and the distant metastasis was increased for patients with poststyloid space extension Conclusions The poststyloid space extension was an important prognostic factor with poorer treatment outcome It is reasonable to classifiy such condition as stage T 3 of nasopharyngeal carcinoma