鼻咽癌分期的新建议(Ⅱ)——1422例5年随访结果

A NEW PROPOSAL FOR CLINICAL STAGING OF NASOPHARYNGEAL CARCINOMA (Ⅱ)

本文按照1422例鼻咽癌放射治疗后随访5年的结果,将T和N有关因素与5年生存率和远转移率分别作比较后提出:一、原发灶(T)分期按局限鼻咽(T1)、邻近超腔T2和远隔超越腔(T3)分为三个档次;二、转移淋巴结(N)分期应按所在颈区、长径大小及其活动度综合考虑,分为N0、N1、N2、N3四个档次,其中长径以≤5cm和≥8cm划分。单或双侧颈淋巴结转移的预后无明显差异;三、T、N、M组合方面,因N3的5年生存率仅6.25％～19.05％,T3尚有33.33％,建议T3为Ⅲ期,N3为Ⅳa为宜;远转移(M1)的预后极差,应和晚期的T或N有所区别而划为Ⅳb。本文对影响分期的各因素进行了讨论,对长沙分期、AJCC和Ho方案作了比较,显示本方案更能反映分期在指导制订治疗方案和评估预后的作用。

Clinical stage classification of 1422 patients with nasopharyngeal carcinoma (NPC) treated from Jan. to Dec. 1985 in this hospital was analysed according to the clinical findings, CT scan and the long term results (5- year survival rate) A new cl inical staging classification has been suggested as follows The primary tumor (T) staging was divided into 3 levels: Tl . Limited to the nasopharynx; T2: Adjacent extranasophary-ngeal extension (included nasal cavity, oropharynx and prestyloid space); T3: Distant extr-anasopharyngeal extension (such as retrostyloid space, involvement of cranial nerve, erosion of the base of the skull and paranasal sinus etc.); The neck lymph node (N) staging was divided into 4 levels according to their size, mobility and location (upper neck, lower neck or supraclavicular fossa). It is reasonable to classify the N staging by the size of 5cm and 8cm in diameter of the lymph node.The 5-year survival rate in patients with T3 was 33.37% and only 6.25% to 19.05% in those with N3 So that we suggested that T3 should be classified in Ⅲ stage and N3 in Ⅳa. The pa- tient with distant metastasis (M) had worse prognosis than those with local advanced T or N staging and should be classified in stage Ⅳb.The comparison of several TNM staging systems and this new proposal has also been discussed.