鼻咽癌放疗后颈部淋巴结残留或复发对预后的影响

Effect of residual or recurrent cervical lymph node on prognosis of the nasopharyngeal cancer after radiotherapy

目的探讨鼻咽癌放疗后颈部淋巴结残留或复发对预后的影响。方法对67例鼻咽癌放疗后颈部淋巴结残留或复发而原发灶未复发的患者的临床病理资料进行回顾分析。选择性别、年龄、原发癌病理类型、残留或复发淋巴结大小、累及的侧数、淋巴结累及区域、累及区域数量、复发淋巴结的手术方式、颈动脉是否受侵、术后是否有严重并发症、是否补充放疗、是否复发、有无远处转移等临床病理因素,用χ2检验和Cox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。结果单因素分析显示有无远处转移与预后明显相关,多因素分析结果表明,残留或复发淋巴结大小、是否累及Ⅴ区、残留或复发淋巴结累及区域数量、手术方式和有无远处转移与预后明显相关。Kaplan-Meier法进行生存分析显示颈部淋巴结残留或复发患者再次治疗的总1、3、5年生存率分别为88.6%、52.2%、38.6%,而采用根治性手术较采用局部手术生存率高。结论远处转移是影响鼻咽癌放疗后颈部淋巴结残留或复发患者预后的决定性因素。而残留或复发淋巴结大小、是否累及Ⅴ区、累及区域数量和手术方式也是重要因素,根治性手术可提高生存率。

OBJECTIVE To analyze the effect of residual or recurrent cervical lymph node on prognosis of the nasopharyngeal cancer after radiotherapy. METHODSThe clinical and histopathological data of 67 nasopharyngeal cancer patients with residual or recurrent cervical lymph node after radiotherapy between 2004 and 2006 were retrospectively analyzed. The influence factors of prognosis for patients with residual or recurrent cervical lymph node were evaluated. The influence factors included sex, age, histological grade of primary tumor, lymph node location, size, involved level, the number of level involved, operative methods, involvement of carotid artery, complications, further radiotherapy, recurrence after surgery, and distant metastasis. Cox model were used for the analysis. Statistical analysis of survival rate of the patients with residual or recurrent cervical lymph node was performed using Kaplan-Meier method.RESULTS In the univariate analysis, it was confirmed that the distant metastases correlated to prognosis. In the COX model analysis, the significant factors were lymph node size, the Ⅴ level involvement, the number of level involved, distant metastasis and operative methods of lymph nodes. Kaplan-Meier analysis showed that overall survival rates of 67 NPC patients with residual or recurrent cervical lymph node who received re-treatment were 88.6%, 52.2% and 38.6% at 1, 3 and 5 years, respectively. CONCLUSION Distant metastasis is the key factor of prognosis for NPC patients with cervical failure after radiotherapy. Radical dissection can increase survival rate.