基于MRI鼻咽癌咀嚼肌间隙侵犯的预后分析

Analysis of Prognosis of Masticator Space Involvement in Nasopharyngeal Carcinoma Based on MRI

目的探讨咀嚼肌间隙侵犯对鼻咽癌预后的影响及其在T分期中的意义。方法回顾性分析经病理确诊的442例初诊无远处转移鼻咽癌患者的临床及影像资料,将侵犯翼内肌的病例归为T3期,咀嚼肌间隙除外翼内肌病例归为T4期,将颅底骨质、颅内、鼻窦等侵犯病例作为对照研究。比较此种分期方法对鼻咽癌患者预后的影响及意义。以总生存率、无局部复发生存率及无远处转移生存率为主要预后指标。应用Kaplan-Meier法分析,差异比较应用Log-rank检验。采用双侧检验,P<0.05为差异有统计学意义。结果 T3翼内肌组与T4咀嚼肌间隙除外翼内肌组总生存率差异有统计学意义(P=0.02),两者无局部复发生存率、无远处转移生存率差异无统计学意义(P=0.55;P=0.09)。T3翼内肌组与T4颅内、鼻窦等组总生存率、无远处转移生存率差异有统计学意义(P=0.02;P=0.01)。T3翼内肌组与T3颅底骨质组总生存率、无局部复发生存率及无远处转移生存率差异均无统计学意义(P>0.05)。T3与T4分期总生存率、无远处转移生存率差异有统计学意义(P=0.001,P=0.004),临床TNM分期Ⅲ期、Ⅳa期总生存率、无局部复发生存率、无远处转移生存率差异均有统计学意义(P=0.002,P=0.025,P=0.003)。结论咀嚼肌间隙侵犯影响鼻咽癌患者的总生存率,侵犯咀嚼肌间隙部位不同对预后的影响有一定差异。

Objective To analyze the prognosis of masticator space involvement in NPC and evaluate the value of masticator space involvement in T-staging.Methods All the biopsy-proven newly diagnosed non-metastatic NPC 442 patients were collected. Medial pterygoid muscle involvement were classified as stage T3 group. Masticator space （except for medial pterygoid muscle） were classified as stage T4 group. Skull base, intracranial and paranasal sinuses involvement were used as a control group. The following endpoint were assessed：overall survival rate （OS）, local recurrence-free survival （LRFS）, distant metastasis-free survival （DMFS）. Using Kaplan-Meier method, the differences were compared using the Log-Rank test. A two-sided test, P〈0.05 had significant difference. Results Overall survival of T3 medial pterygoid muscle group and T4 masticator space except for the medial pterygoid muscle group was statistically significant （P=0.02）, local recurrence-free survival and distant metastasis-free survival rates were not statistically significant between them（P=0.55, P=0.09）. overall survival, distant metastasis free survival rate of T3 medial pterygoid muscle group and T4 of intracranial sinus group were statistically significant （P=0.02, P=0.01）. Overall survival rate, local relapse-free survival and distant metastasis-free survival were not statistically significant between T3 medial pterygoid muscle group and T3 of skull base （P〉0.05）. Overall survival, distant metastasis-free survival rate of staging T3 and T4 were statistically significant （P=0.001, P=0.004）. Overall survival rate, local relapse-free survival and distant metastasis-free survival rate of clinical-stage III and IVa were statistically significant （P=0.002, P=0.025, P=0.003）. Conclusion Masticator space involvement in NPC influenced the rate of overall survival, and if the infiltration of masticator space is different, the prognosis is different.