鼻咽癌疗后骨转移程度对预后的影响

Prognostic impact of degree of bone metastasis in patients with nasopharyngeal carcinoma after radiochemotherapy

目的分析鼻咽癌放化疗后骨转移程度对预后的影响。方法回顾分析1997—2007年间在南方医院接受放化疗且疗后有骨转移的109例鼻咽癌患者的预后。Kaplan—Meier法计算生存率，Logrank法单因素预后分析，Cox回归模型多因素预后分析。结果5年随访率为97．2％。全组患者1、2、3、5年总生存率分别为67．9％、48．6％、32．9％、17．4％。全组骨转移数≤3个（43例）与〉3个（66例）的1、2、3、5年生存率分别为90．7％与53．0％、81．4％与27．3％、72．1％与6．2％、34．9％与4．2％（P=0．000）。骨转移数〉3个中有与无合并其他部位转移的1、2、3、5年生存率分别为56．5％与72．1％、21．7％与30．2％、3．1％与13．0％、0．0％与6．5％（P=0．866）。多因素分析显示骨转移数目〉3是影响预后的因素（P=0．000）。结论鼻咽癌疗后骨转移灶数目增多是影响预后的重要因素，但是否需较积极治疗尚待探究以进一步完善鼻咽癌分期系统。

Objective To analyze the prognostic impact of degree of bone metastasis in patients with nasopharyngeal carcinoma （ NPC ） after radiochemotherapy. Methods A retrospective analysis was performed on the prognosis of 109 NPC patients who had bone metastases after radiochemotherapy in Nan_fang Hospital from June 1997 to December 2007. The Kaplan-Meier method was used to calculate survival rates; the log-rank test was used for univariate prognostic analysis; the Cox regression model was used for multivariate prognostic analysis. Results The 5-year follow-up rate was 97. 2%. The 1-, 2-, 3-, and 5- year overall survival rates for all patients were 67.9%, 48.6%, 32. 9%, and 17.4%, respectively. The 1-, 2-, 3-, and 5-year survival rates for the 43 patients with not more than 3 bone metastases and the 66 patients with more than 3 bone metastases were 90. 7% vs. 53.0% , 81.4% vs. 27. 3% , 72. 1% vs. 6. 2% , and 34. 9% vs. 4. 2%, respectively （P= 0.000）. In the patients with more than 3 bone metastases, the 1-, 2-, 3-, and 5-year survival rates for those with and without other metastatic sites were 56. 5% vs. 72. 1%, 21.7% vs. 30. 2%, 3. 1% vs. 13.0%, and 0.0% vs. 6. 5%, respectively （P= 0. 866 ）. The multivariate analysis showed that more than 3 bone metastases were an adverse prognostic factor in the patients （ P = 0. 000）. Conclusions The number of bone metastases is an important prognostic factor in NPC patients after radiochemotherapy. Patients with not more than 3 bone metastases have better survival than those with more than 3 bone metastases, and aggressive treatment should be considered. In addition, the staging system of NPC needs to be improved.