鼻咽癌调强放射治疗结束时T残留的影响因素分析

Factors influencing image T residue at the end of intensity-modulated radiotherapy for nasopharyngeal carcinoma

目的分析鼻咽癌(nasopharyngeal carcinoma,NPC)放疗结束时T残留的影响因素,减少T残留,提高NPC患者疗效。方法收集2008年6月至2016年6月在广西某三级甲等医院住院治疗的691例NPC患者的临床资料,分析放疗结束时T残留情况及相关影响因素,计算残留率,采用logistic回归模型进行危险因素筛选。结果 691例NPC患者中发生T残留227例,残留率为32.85%。单因素分析显示,年龄≥50岁组残留率高于年龄<50岁组(39.91%vs 29.60%;χ~2=7.191,P=0.007);男性残留率高于女性(35.12%vs 26.74%;χ~2=4.343,P=0.037);不同临床分期残留率、T分期残留率比较,差异有统计学意义(P<0.001);口咽、喉咽、鼻腔、椎前肌、颈动脉鞘区、翼内肌、翼外肌、颅底、鼻窦、颞下窝、颅内、海绵窦、颅神经和喉咽等部位有肿瘤侵犯组残留率均高于无侵犯组(P<0.05)。多因素分析结果显示,男性、年龄≥50岁和口咽、颅底、海绵窦、颅神经等部位有肿瘤侵犯是NPC放疗结束发生T残留的独立影响因素(P<0.05)。结论制定NPC放疗方案时,充分考虑性别、年龄因素和口咽、颅底、海绵窦、颅神经等部位有无肿瘤侵犯,可有效减少T残留。

Objective To analyze factors influencing imaging T residual in nasopharyngeal carcinoma （NPC） patients. Methods From June 2008 to June 2016,691 NPC patients were collected. The chi-squared test was used to compare residual rates among groups,and factors affecting imaging T residual were identified using logistic regression. Results Residual rate was significantly higher among patients older than 50 yr than among those younger,and it was significantly higher among men than women （P〈0.05）. The rate also differed significantly among clinical stages and T stage. Rate differed significantly among patients with different tumor staging parameters （oropharyngeal, hypopharyngeal, nasal cavity, anterior vertebral muscle, carotid sheath area, medial pterygoid muscle,lateral pterygoid muscle, skull base, paranasal sinus, infratemporal fossa,intracranial, cavernous sinus, cranial nerve ）. Rate was significantly higher among patients with metastatic tumors than among those with non-metastatic tumors （P〈0.05）. Muhifactorial analysis identified the following factors influencing nasopharyngeal imaging T （P〈0.05） ： gender, age, tumor staging parameters （oropharynx, skull base, cavernous sinus and cranial nerve）. Conclusion Risk factors of nasopharyngeal imaging T residual were male gender,older age and metastasis to oropharynx, base of the skull, cavernous sinus and cranial nerve.