调强放疗时代咽后淋巴结与鼻咽癌预后关系的研究

The Relationship between the Retropharyngeal Node and the Prognosis of Nasopharyngeal Carcinoma in the Intensity-modulated Radiotherapy Era

目的探讨咽后淋巴结大小、侧数等参数对鼻咽癌预后的影响。方法回顾性分析1197例首诊、无远处转移且经过IMRT治疗的鼻咽癌,评价咽后淋巴结(RPN)及其具体参数如淋巴结侧数、大小等对鼻咽癌预后的影响。结果1197例中,1027例发生淋巴结转移,其中发生RPN有74. 0%(886/1197)。RPN是远处转移的独立预后因素(P=0. 025)。RPN侧数对远处转移(P=0. 006)和疾病进展(P=0. 001)有统计学意义。多因素分析中,RPN侧数是PFS的独立预后因素(P=0. 015)。在N1期中,RPN侧数是无疾病生存及无进展生存具有统计学意义的影响因素(P值分别为0. 045和0. 049)。同时双侧咽后淋巴结和单侧颈部淋巴结转移是远处转移和疾病进展的不良预后因素。结论 RPN及其侧数均是影响鼻咽癌预后的因素。在N1期中,同时发生双侧咽后淋巴结和颈部淋巴结转移患者的预后最差。

Objective To investigate the prognostic value of retropharyngeal lymphadenopathy for NPC when patients were treated by intensity-modulated radiotherapy( IMRT). Methods 1197 patients were retrospectively studied. All were staged by magnetic resonance imaging( MRI) and irradiated with IMRT. The prognostic value of the retropharyngeal node( RPN) and its characteristics including laterality,size were evaluated. Results The incidence of RPN metastasis was 74. 0%. RPN metastasis was an independent prognostic factor for distant failures( P = 0. 025). RPN laterality has significant impacts on both distant failure( P = 0. 006) and disease progression( P = 0. 001). In multivariate analyses,RPN laterality was an independent factor for progression-free survival( PFS)( P = 0. 015). In N1 disease,RPN laterality showed significant differences for disease free survival( DSS) and PFS( P = 0. 045 and 0. 049,respectively). Moreover,the involvement of both bilateral RPN and cervical lymph node( CLN) was an independent adverse factor( P < 0. 01) for distant failure and disease progression. Conclusion Not only RPN metastasis but also RPN laterality is considered as an important prognostic factor for NPC. In N1 stage,involvement of both bilateral RPN and CLN have an adverse influence for NPC patients. Further studies about RPN laterality,especially in N1 stage should be conducted.