鼻咽癌治疗后生存率和预后总结与分析

Statistics and analysis of survival rate and prognosis of patients with nasopharyngeal carcinoma after treatment

目的总结分析鼻咽癌患者治疗后复发或转移的原因及其与治疗前相关因素的关系,为制定鼻咽癌治疗策略提供依据。方法收集2001年1月~2003年12月鼻咽癌患者669例,首程治疗前均行影像学检查和鼻咽病理证实的非转移鼻咽癌接受治疗。根据患者症状、体征、病理学及相关部位的影像学检查确定治疗方案,生存分析用Kaplan-Meier法,统计总生存、无瘤生存、无局部复发及远处转移生存率。统计5年累积鼻咽、颈部复发及远处转移率。结果本组鼻咽癌患者5年总生存率、无瘤生存率、局部复发率、远处转移率分别为65.3%、59.7%、18.9%、20.3%。T1、T2、T3、T4患者的5年局部复发率分别为8.2%、8.6%、11.3%、11.5%;N0、N1、N2、N3的颈部复发率分别为3.1%、4.3%、3.4%、4.3%;N0、N1、N2、N3的5年远处转移率分别依次为9.4%、21.3%、21.8%及36.5%。结论复发或转移是影响鼻咽癌治疗后生存率和预后的重要因素。随着放射技术的发展,可望进一步提高鼻咽癌的局部控制率从而达到提高生存率的目的。提高鼻咽癌患者的生存率,关键在于降低鼻咽癌患者的远处转移率。

Objective To summarize the reasons of relapse or metastasis in patients with nasopharyngeal carcinoma（ NPC）,and to analyze their relationships with factors before initial treatment for providing basis of therapeutic strategy for NPC. Methods From Jan 2001 to Dec 2003,669 patients with non-metastatic NPC received initial treatment in our department. The treatment programmes were developed according to their symptoms,signs,pathological and imageological results. The overall survival rate,disease-free survival rate,survival rate without local recurrence and distant metastasis were analyzed by Kaplan-Meier statistical method. 5-year cumulative rates of recurrence in nasopharynx and neck and systemic metastasis were calculated. Results The overall 5-year survival rate,tumor-free survival rate,local recurrence rate,and systemic metastasis rate were 65. 3%,59. 7%,18. 9% and 20. 3%,respectively. The 5-year cumulative rates of nasopharyngeal recurrence in T1,T2,T3 and T4 were 8. 2%,8. 6%,11. 3% and 11. 5%. The 5-year cumulative rates of cervical recurrence in N0,N1,N2 and N3 were 3. 1%,4. 3%,3. 4% and 4. 3%. And the 5-year cumulative rates of systemic metastasis in N0,N1,N2 and N3 were 9. 4%,21. 3%,21. 8% and 36. 5%. Conclusion Recurrence and metastasis are important factors affecting the survival rate and prognosis of patients with NPC. With the development of radiologic technology,it is probable to further improve the local control of NPC and achieve improvement of survival rate.The key to improve the survival rate of patients with NPC is to reduce systemic metastasis rate.