鼻咽癌放化疗局部失败的相关因素分析

Risk factors analysis of local failure following radiotherapy and chemotherapy to nasopharyngeal carcinoma

目的:探讨鼻咽癌放化疗后局部失败(残留或复发)的相关影响因素。方法:对308例鼻咽部原发癌患者的临床病理资料进行回顾分析。选择性别、年龄、T分级、N分级、原发癌病理类型、有无颈淋巴结转移、颈转移淋巴结大小、颈淋巴结转移侧数、颈淋巴结转移累及区域、放疗方法、有无同步化疗等临床病理因素,用χ2检验和Logistic回归进行单因素和多因素分析,并用Kaplan-Meier法对残留和复发患者进行生存分析。结果:在308例头颈部原发鳞状细胞癌患者中,93例(30.2%)发生原发灶和颈部的残留或复发。单因素分析显示,T分级(P<0.01)、N分级(P<0.01)、有无颈淋巴结转移(P<0.05)、颈转移淋巴结大小(P<0.05)、颈淋巴结转移侧数(P<0.01)与残留或复发有关。多因素分析结果表明,仅T分级与残留或复发明显相关。用Kaplan-Meier法进行生存分析显示71例残留或复发患者再次治疗的1年、3年、5年生存率分别为77.2%、40.4%、22.4%。结论:原发癌T分级是鼻咽癌治疗局部失败的决定性因素。而有无颈淋巴结转移、原发癌N分级、颈淋巴结转移侧数、颈淋巴结大小是影响因素和T分级的协同因素,但不是导致残留和复发的的初始和根本因素。鼻咽癌侵犯骨时易导致治疗失败。治疗失败者经再次治疗可以提高生存率。

Objective： To analyse the risk factors involved in local failure following radiotherapy and chemotherapy to nasopharyngeal carcinoma. Method：A retrospective analysis was carried out to review the histopathological data from 308 NPC patients who recieved medical treatment between 2004 and 2006. The incidence and the risk factor for local treatment failure were evaluated in a model that included the following factors., sex, age, T and N staging, histological grade of primary tumor, presence of cervical lymph node metastasis, size and laterals of positive neck nodes, levels involved, ways of radiation and condition of concurrent chemotherapy. Univariate ？（2 test and multivariate stepwise logistic regression model were used for the analysis. Statistical analysis of survival of patients with local residues and recurrence was performed using Kaplan-Meier method. Result： Ninty-three cases （30.2%） presented local residues and recurrence in 308 patients of nasopharyngeal carcinomas. In the univariate analysis, it was confirmed that the following variables correlated to local failure, i. e. , T staging（P〈0.01）, N staging（P〈0.01）, presence of cervical lymph node metastasis（P〈0.05）, size and laterals of positive neck nodes （P〈0.05, respectively）. In the multivariate analysis, the most ignificant risk factors for local failure were the T staging only. Kaplan-Meier analysis showed that overall survival rates of 71 NPC patients with local residues and recurrence who received re-treatment were 77.2% at 1 year, 40.4% at 3 years, 22.4% at 5 years, respectively. Conclusion：T staging is the key risk factors in determining the development of local failure following radiotherapy or chemotherapy in NPC patients. Patients with primary tumor infiltrating bone have the higher risk of developing local residues and recurrence. Retreatment to the patients suffering from local failure can imrove survival rates.