68例首诊伴单纯骨转移鼻咽癌患者预后分析

Prognostic analysis of 68 patients with initially diagnosed bone-only metastatic nasopharyngeal carcinoma

目的 探讨首诊伴单纯骨转移鼻咽癌患者的预后影响因素。方法 选取1997—2015年汕头大学医学院附属肿瘤医院收治的68例首诊伴单纯骨转移鼻咽癌患者,49接受放化疗。Kanplan-Meier法计算OS率,Logrank法单因素预后分析,Cox模型多因素预后分析。结果 中位随访时间为95.3个月,1、2、3、5年OS率分别为53%、38%、21%、15%,中位OS期13.4个月。单因素分析结果显示脊柱转移、骨转移数目、疗前LDH水平、原发病灶放疗技术、放疗剂量、原发病灶近期疗效均是影响OS期因素（P=0.02、0.01、0.00、0.02、0.02、0.01）,多因素分析显示骨转移数目≤3个、原发病灶放疗剂量〉65 Gy、IMRT技术是影响OS期的因素（P=0.03、0.02、0.04）。结论 对于骨转移数目≤3个的首诊伴单纯骨转移鼻咽癌患者,应予以积极治疗,包括采用IMRT技术、原发病灶放疗剂量〉65 Gy,以争取原发病灶的近期疗效达到CR,临床意义重大。

Objective To analyze the prognostic factors in patients with initially diagnosed bone-only metastatic nasopharyngeal carcinoma （NPC）. Methods We collected the data of 68 patients with initially diagnosed bone-only metastatic NPC admitted to The Affiliated Tumor Hospital of Shantou University Medical College from 1997 to 2015. Forty-nine patients received chemoradiotherapy. The Kaplan-Meier method was used to calculate the overall survival rate;the log-rank test was used for univariate prognostic analysis;the Cox model was used for multivariate prognostic analysis. Results The median follow-up was 95.3 months. The 1-, 2-, 3-, and 5-year overall survival （OS） rates were 53%, 38%, 21%, and 15%, respectively. The median OS time was 13.4 months. The univariate prognostic analysis showed that spinal metastases, the number of bone metastases, lactic dehydrogenase level before treatment, the radiotherapy technology and dose for primary tumor, and the short-term outcome of primary tumor were associated with OS （P=0.02,0.01,0.00,0.02,0.02,0.01）. The multivariate prognostic analysis showed that ≤3 bone metastases, dose to primary tumor〉65 Gy, and intensity-modulated radiotherapy （IMRT） were favorable prognostic factors for OS （P=0.03,0.02,0.04）. Conclusions For patients with initially diagnosed bone-only metastatic NPC, active treatment （IMRT, dose to primary tumor〉65 Gy） should be considered for those with ≤3 bone metastases to achieve a complete response of primary tumor.