根治性放疗后远处转移鼻咽癌患者的预后分析

Prognostic analysis of nasopharyngeal carcinoma patients with distant metastasis after curative radiotherapy

目的：分析鼻咽癌根治性放疗后发生远处转移患者的预后及其影响因素。方法回顾性分析根治性放疗后发生远处转移的184例鼻咽癌患者的临床资料，分析其预后及其影响因素。结果全组患者的中位生存时间为12个月，1、2、3年生存率分别为50．6％、30．7％和20．9％。 Cox单因素分析结果显示，放疗后发生转移患者的预后与患者性别、年龄、初诊时T分期、临床分期、初诊治疗时化疗的周期数、初诊放疗技术和剂量无关（均P＞0．05），而与初诊时N分期、初诊时是否化疗、放疗结束至发生远处转移的时间间隔、转移部位、转移后是否化疗及化疗的周期数、转移后是否行姑息放疗有关（均P＜0．05）。初诊时的N分期越晚、初诊时有化疗者、治疗后发生转移的间隔时间短者、多脏器转移以及转移后无放疗或化疗者预后较差（均P＜0．05）。多因素分析结果显示，初诊时N分期、转移部位、转移后是否化疗、转移后是否姑息放疗、初治放疗结束至远处转移的时间间隔是影响远处转移鼻咽癌患者预后的独立因素（均P＜0．05）。结论初诊时N分期、转移部位、转移后是否化疗、转移后是否姑息放疗、初治放疗结束至远处转移的时间间隔是影响远处转移鼻咽癌患者预后的独立因素。全身化疗和局部姑息放疗是转移性鼻咽癌患者的主要治疗方式。

Objective To analyze the prognosis and its influencing factors for nasopharyngeal carcinoma patients with distant metastasis after radical radiotherapy.Methods Clinical data of 184 cases of nasopharyngeal carcinoma after radical radiotherapy with distant metastases were retrospectively reviewed and the factors affecting prognosis were analyzed.Results The median survival time was 12 months for the whole group, and the 1-, 2-, and 3-year survival rates were 50.6%, 30.7%and 20.9%, respectively.Cox univariate analysis showed that the prognosis of patients with metastasis after radiotherapy was significantly related with The N stage, chemotherapy, time interval between the end of radiotherapy and occurrence of distant metastasis, metastatic sites, chemotherapy after metastasis, cycles of chemotherapy and palliative radiotherapy after metastasis （ P 〈0.05 ） , but not significantly related with sex, age, T stage, clinical stage, cycles of chemotherapy, radiation technique and radiation dose for initial treatment （ P ＆gt;0.05 ） . Advanced N stage, no chemotherapy, short time interval between the end of radiotherapy and occurrence of distant metastasis, multiple metastases, no radiotherapy or chemotherapy for metastases were predictive for poor prognosis （ P 〈0.05）.Multivariable analysis indicated that factors including N stage at initial diagnosis, metastatic sites, whether or not chemotherapy was given, the time interval between the end of radiotherapy and the occurrence of distant metastasis were independent factors affecting the prognosis of nasopharyngeal carcinoma patients with distant metastasis after radiotherapy.Conclusions N stage at initial diagnosis, metastatic sites, whether or not chemotherapy was given, the time interval between the end of radiotherapy and the occurrence of distant metastasis are independent factors affecting the prognosis for nasopharyngeal carcinoma patients with distant metastasis after radiotherapy.Systemic chemotherapy and local palliative radiotherapy are the primary treatment for nasopharyngeal carcinoma patients with metastasis.