基于调强放射治疗鼻咽癌患者咀嚼肌间隙受侵预后价值分析

Analysis of prognosis of masticator space involvement in nasopharyngeal carcinoma in the era of intensity-modulated radiotherapy

目的评估咀嚼肌间隙受侵对鼻咽癌(NPC)预后及分期的影响。方法收集潍坊市人民医院放疗科171例初治NPC患者,所有患者均行鼻咽部及颈部磁共振成像检查。根据NPC患者的咀嚼肌间隙受侵状况分为无翼肌受侵组(1组)、翼内肌受侵组(2组)、翼外肌合并(或不合并)翼内肌受侵组(3组)和翼外肌以外的软组织间隙受侵组(4组)。用Kaplan-Meier法计算生存率,用Logrank检验比较组间差别。结果咀嚼肌间隙入侵总发生率为36.2%(62/171)。4组患者5年总生存率(OS)分别为89.9%,78.4%,49.2%,40.4%(P=0.043)。5年无进展生存率(PFS)分别为81.9%,74.3%,77.2%,75.6%(P=0.925)。5年无局部复发率(LRFS)分别为95.0%,73.3%,71.6%,67.8%(P=0.102)。5年无远处转移生存率(DMFS)分别为88.3%,76.5%,68.7%,60.1%(P=0.017)。各组之间在OS、DMFS中存在不同差异,而PFS,LRFS间无明显差异。结论咀嚼肌间隙受侵是影响NPC患者预后的重要因素,建议将不同的咀嚼肌间隙受侵情况划分成不同的分期。

Objective To analyze the prognosis and evaluate the value in TNM stage of masticator space involvement（MSI） in nasopharyngeal carcinoma（NPC）. Methods One hundred and seventy one initial diagnosis patients with NPC who underwent magnetic resonance imaging（MRI） scan of nasopharynx and neck were analyzed retrospectively treated with intensity-modulated radiotherapy（IMRT） at the Department of Radiation Oncology of Weifang People＇s Hospital. The MSI was divided into 4 groups according to different anatomic features as follows,without MSI,with Medial pterygoid muscle involvement,with lateral and/or Medial pterygoid muscle involvement but without infratemporal fossa involvement and with extensive soft tissue infiltration beyond the lateral surface of the lateral pterygoid muscle. The Kaplan-Meier method was used to calculate survival rates,and the log-rank test was used to compare survival differences. Results The frequency of MSI was 36. 2%（62/171）. The 5-year overall survival（OS） was 89. 9%,78. 4%,49. 2% and40. 4%（P = 0. 043）,respectively. The 5-year progression-free survival（PFS） was 81. 9%,74. 3%,77. 2% and 75. 6%（P = 0. 925）,respectively. The 5-year local recurrence-free survival（LRFS） was 95. 0%,73. 3%,71. 6% and 67. 8%（P = 0. 102）,respectively. The 5-year distant metastasis-free survival（DMFS） was 88. 3%,76. 5%,68. 7% and 60. 1%（P = 0. 017）,respectively. Significant differences in OS and DMFS were observed among different groups while no significant difference in LRFS and PFS were observed among the four groups. Conclusion MSI is an important prognostic factor for NPC patients,it is suggested that different masticatory space invasion be divided into different stages.