鼻咽癌骨转移患者的生存危险分层分析研究

RISK CLASSIFICATION OF THE SURVIVAL OF NASOPHARYNGEAL CARCINOMA PATIENTS WITH BONE METASTASES

目的分析探讨鼻咽癌骨转移患者生存、预后因素和治疗模式意义之间的关系。方法本研究纳入自1997年1月~2002年12月收治于我院鼻咽癌初始治疗后发生单纯骨转移患者共116例,通过卡方检验验证无疾病生存期与临床病理学因素之间的关系。通过单因素和多因素Cox风险回归分析模型确立独立预后风险因素。结果本次研究中鼻咽癌骨转移患者的中位生存期为33.3个月。通过单因素和多因素Cox风险回归分析模型得知,年龄、局部复发、二次转移、无疾病生存间期长短和治疗模式是独立、有意义的预后影响因素。鼻咽癌骨转移患者高风险亚组（19.4个月）、低风险亚组（49.5个月）有着截然不同的预后（p〈0.001）。亚组分析中,鼻咽癌骨转移低风险亚组患者,相对于单纯化疗组,接受放化疗的患者有着更长的生存期（p〈0.001）。而在高风险亚组中,两组患者未有明显的生存差异（p=0.135）。结论鼻咽癌骨转移低风险亚组患者能够从放化疗中获益,带来更长的生存期。

Objective To explore therelationship among the survival, prognostic factors, and significances of treatment modes in nasopharyngeal carcinoma （NPC） patients with bone metastasis. Methods A total of 116 cases admitted to our hospital from January 1997 to December 2002 and developing with bone metastasis after the initial treatment NPC were selected. The correlation between disease - free interval （DFI） and clinicopathologic factors was assessed by the Chi - square test. Independent prognostic risk factors were determined by univariate and multivariate analyses of Cox proportional hazards regression models. Results The median overall survival Of bone metastatic NPC patients was 33.3 months. By univariate and multivariate analyses of Cox proportional hazards regression models, the age, local recurrence, subsequent metastasis, survival length of DFI and treatment modality were independently sig- nificant prognostic factors. The outcomes of bone metastatic NPC patients in low - and high - risk subgroup were sig- nificantly different （p 〈 0. 001 ）. In the subgroup analysis, those taking chemoradiotherapysurvived longer than those taking right chemotherapy （p 〈 0. 001 ）, but there were no significant difference in survival time in the high - risk subset group （p = 0. 135 ）. Conclusion Bone metastatic NPC patients in low - risk subsetcan benefit from CRT and have a longer survivaltime.