内镜手术治疗首诊局部晚期鼻咽癌的疗效分析

Clinical efficacy of endoscopic nasopharyngectomy for initially diagnosed advanced nasopharyngeal carcinoma

目的 探索内镜手术对首诊局部晚期鼻咽癌的临床疗效。方法 回顾性分析2007年8月至2015年9月间于广东省人民医院、青岛大学医学院附属医院、首都医科大学宣武医院耳鼻咽喉头颈外科首诊为局部晚期鼻咽癌且行内镜下鼻咽颅底肿物切除术的临床病例45例，其中男性27例（60.0%），女性18例（40.0%），年龄13-75岁，中位年龄53岁。发病时间1-72个月，中位时间5个月。病理类型：非角化性未分化型癌28例（62.2%），鳞状细胞癌15例（33.3%），非角化性分化型癌2例（4.4%）。TNM分期：Ⅲ期16例（35.6%），Ⅳ期29例（64.4%）；T分期3期16例（35.6%）、4期29例（64.4%）；N分级0级38例（84.4%）、2级7例（15.6%）；所有患者均未出现远处转移（M分级均为0级）。所有患者均接受内镜下鼻咽颅底肿物切除术，术后予放疗或同步放化疗。随访后的结果用SPSS19.0软件进行统计学分析，用Kaplan－Meier法和Log－rank检验进行总体生存率的估计，用Cox比例风险模型进行影响手术预后的单因素分析。结果 45例患者的随访时间6-97个月，中位随访时间36个月，其中存活36例（80.0%），死亡9例（20.0%）；复发15例（33.3%）。1、3、5年累积生存率分别为90.6%、81.0%、76.0%。单因素分析显示是否复发、是否出现远处转移与患者的预后有关（χ^2值分别为16.644和6.451，P值均〈0.05）。结论 内镜手术治疗局部晚期鼻咽癌，可获得较高的患者生存率和较低的复发率及远处转移率。

Objective To explore the clinical efficacy in patients who underwent endoscopic nasopharyngectomy for primary advanced nasopharyngeal carcinoma （ NPC ）. Methods Forty-five patients who underwent endoscopic nasopharyngectomy for primary advanced NPC encountered between Aug. 2007 and Sep. 2015 were retrospectively reviewed. Twenty-seven patients were male （60. 0% ）, and 18 patients were female （40.0%）, the ratio of male to female was 3： 2. The median age was 53 years old （ranged from 13 to 75 years old）. The median onset time was 5 months （ranged from 1 to 72 months）. TNM stage： 16 cases were at stage III （35.6%）, 29 at stage IV （64.4%） ; T3 16 cases （35.6%）, T4 29 cases （64.4%）; NO 38 cases （84.4%）, N2 7 cases （15.6%）. No patients were found to have distance metastasis. All patients underwent endoscopic resection of lesions. Postoperatively all the patients were treated with radiotherapy or chemoradiotherapy. Using SPSS 19.0 software, Kaplan-Meier and Log-rank test were done for the assessmen of survival rate ; Cox proportional hazards model was used for the univariate analysis of prognostic factors. Results The median follow-up was 36 months （ranged from 6 to 97 months） , with 36 cases surviving （80.0%） , 9 cases died （20.0%） ; 15 cases relapsed （33.3%）. The overall 1 year survival rates （SR） , 3 year SR, 5 year SR was 90.6% , 81.0% , 76.0% , respectively. The survival univariate analysis indicated the recurrence and metastasis were correlated with the survival （χ^2 value was 16. 644, 6. 451, respectively, all P 〈 0.05 ）. Conclusion The patients who undergo endoscopic nasopharyngectomy for primary advanced NPC have better survival rate with lower recurrent rate and metastatic rate.