鼻咽癌的临床预后因素分析

Analysis on prognostic factors of nasopharyngeal carcinoma

目的通过对行根治性放疗的鼻咽癌 (NPC)病例资料的分析 ,探讨影响NPC预后的临床因素及预后指数模型在NPC中的应用价值。方法选择 1992年 9月～ 1993年 2月间采用根治性放射治疗的Ⅰ～Ⅳa期鼻咽低分化鳞癌共 84例 ,分析年龄、性别、临床分期、放疗分割方法、化疗与否、治疗前血清VCA IgA、细胞免疫功能状态等因素与鼻咽癌预后的关系 ,生存统计采用Kaplan Meier法和Log rank检验 ,多因素分析采用Cox逐步回归模型 ,并以Cox模型所得各因素的变异系数乘以分组值计算预后指数。结果全组中位生存期 72个月 ,1、3、5年生存率分别为 83 2 %、73.2 %、6 9.6 %。单因素分析显示临床分期、放疗分割方法、治疗前血清VCA -IgA、细胞免疫功能状态与预后有关 ,多因素分析显示仅临床分期、放疗分割方法、细胞免疫功能状态为NPC的显著预后因素。综合以上三种因素的预后指数模型能较好地区分不同的预后亚组。结论临床分期、放疗分割方法、细胞免疫功能状态是NPC的独立预后因素。预后指数模型能够较TNM临床分期等单个因素更好地反映预后。

Objective To evaluate the prognostic factors of irradiated nasopharyngeal carcinoma(NPC) with a retrospective analysis.Methods From Sept. 1992 to Feb. 1993,84 cases with stage Ⅰ～Ⅳa nasopharyngeal poor differentiated squamous carcinoma were eligible for the analysis. The variables age, sex, clinical stage, radiation fraction, chemotherapy, VCA IgA titre, cellular immune status were evaluated the significance of prognostic variables in the survival by univariate analysis and Cox stepwise regression model. The prognostic index was calculated.Results The median survival of overall group was 72 months and 1 ,3 ,5 year accumulate survivals were 83.2%,73.2%,69.6% respectively.Conclusion Clinical stage, radiation fraction, cellular immune status before radiotherapy are independent prognostic factors. Prognostic index model can predict the prognosis of NPC more effectively than single variable such as TNM stage.