临床颈部淋巴结阴性鼻咽癌患者放射治疗预后因素分析

Prognostic factors on patients with clinically node-negative nasopharyngeal carcinoma after radiotherapy

目的：分析临床N0期鼻咽癌患者临床资料及生存情况，并探讨其预后因素。方法：回顾性分析1989—05—01—2009—12—31汕头大学医学院附属肿瘤医院放疗科627例临床颈部淋巴结阴性（N。期）鼻咽癌患者的临床资料。所有患者治疗前均行颅底鼻咽部CT扫描。采用60Co7线或直线加速器6MVX射线进行治疗，常规分割，连续放疗。采用面颈联合野照射DT36-40Gy，然后改用双耳前野加双上颈切线野照射。生存率分析采用Kaplan-Meier方法，Log—rank法检验差异性，Cox风险比例模型进行多因素分析。结果：627例临床颈部淋巴结阴性鼻咽癌患者5年总生存率为78．6％，无病生存率为68．9％，疾病相关生存率为79．9％，局部无失败生存率为81．4％，区域无失败生存率为95．9％，局部区域无失败生存率为78．5％，无远处转移生存率为88．4％；10年总生存率为66．6％，无病生存率为55．9％，疾病相关生存率为70．3％，局部无失败生存率为72．8％，区域无失败生存率为91.9％，局部区域无失败生存率为68．8％，无远处转移生存率为85．2％。作为首次治疗的首发失败事件，单纯局部失败率为16．6％（104／627），区域淋巴结失败率为2．4％（15／627），远处转移率为8．6％（54／627）。多因素分析结果显示，T分期是影响No期鼻咽癌患者总生存的独立因素。男性、T晚期和贫血者无病生存率较低。结论：N0期鼻咽癌患者有较好的预后，局部失败是治疗失败的首要原因，T分期是影响总生存率的预后独立因素，男性、T分期和贫血是影响无病生存率的独立预后因素。

OBJECTIVE： To evaluate the outcomes of patients with No nasopharyngeal carcinoma （NPC） treated pri- marily by external beam irradiation,and explore the prognostic factors. METHODS： A total of 627 patients with No NPC undergoing radiotherapy from May 1,1989 to December 31,2009 were retrospectively ana[yzed. Computed tomography （CT） scans of the primary lesion were performed to every patient. All patients received definitive radiotherapy with 60 Co γ/ or 6 MV X rays using conventional fraction at 2 Gy daily,5 fractions per week. The accumulated survival was calculated according to the Kaplan-Meier method. Log-rank test was used to compare the survival difference. Cox proportional haz- ards model was used for multivariate analysis. RESULTS： The 5-year and 10-year actuarial overall survival, disease-free survival, disease-specific survival, local failure-free survival, regional failure-free survival,locoregional failure-free survival, and distant metastasis-free survival rates were 78.6 % and 66.6 %, 68.9% and 55.9%, 79.9 % and 70. 3 %, 81.4% and 72.8% ,95.9% and 91.9%, 78.5% and 68.8%, 88.4% and 85.2% ,respectively. Local recurrence,regional relapse and distant metastases as the first event of treatment failure occurred in 104 （104/627,16.6%）, 15 （15/627,2.4%） and 54 cases （54/627,8.6 %）, respectively. Multivariate analysis showed that T stage was the only independent prognostic factor for overall survival. Male,late T stage and anemia were the factors adversely affect disease-free survival. CONCLUSIONS.. Satisfactory treatment outcomes have been achieved in patients with N0 NPC. Local recurrence represents the predominant mode of treatment failure. T stage is the only independent prognostic factor for overall survival. Male,T stage and anemia are the independent prognostic factors for disease-free survival.