鼻咽癌侵犯海绵窦及局部颅神经受累的MRI表现和预后价值

MRI Findings of Nasopharyngeal Carcinoma Invading Cavernous Sinus and Local Cranial Nerve Involvement and Prognostic Value

目的分析鼻咽癌侵犯海绵窦和局部颅神经的MRI表现及预后的关系。方法收集2010年1月至2011年7月共478例经病理证实鼻咽癌患者的完整临床及MRI资料,分析海绵窦受侵和局部脑神经受累的情况及其对预后的影响。结果鼻咽癌MRI显示海绵窦受侵的发生率为13.6%(65/478);海绵窦区总的颅神经受累率为11.7%(56/478)。全组的5年总生存率(OS)为88%,5年无局部区域复发生存率(LRFS)、无远处转移生存率(DMFS)、无瘤生存率(DFS)分别为91.0%、84.0%、80.0%。单因素分析表明,海绵窦是否受累是影响5年OS、DMFS和DFS的预后因素,颅神经是否受累是影响5年OS的预后因素。多因素分析表明,海绵窦受侵和局部颅神经受侵不是独立的预后因素。结论鼻咽癌MRI能显示海绵窦和颅神经受侵的情况,海绵窦侵犯和局部颅神经侵犯与鼻咽癌的预后相关,但不是一个独立的预后因素。

Objective To analyze MRI findings in nasopharyngeal carcinoma(NPC)cavernous sinus and local cranial nerve involvement and the value of prognosis.Methods The complete clinical and MRI data of 478 patients with nasopharyngeal carcinoma confirmed by pathology from January 2010 to July 2011 were collected to analyze the situation of cavernous sinus invasion and local cerebral nerve involvement and its influence on prognosis.Results MRI showed that cavernous sinus invaded in NPC was 13.6%(65/478).The total cranial nerve involvement rate in the cavernous sinus area was 11.7%(56/478).In all patients,5-years overall survival(OS)rate was 88%,5-years local relapse-free survival(LRFS)rate was 91.0%,5-years distant metastasis-free survival(DMFS)rate was 84.0%,the 5-year disease-free survival(DFS)rate was 80.0%.The single-factor analysis showed that cavernous sinus involvement is 5-years OS,5-years DMFS,and 5-years DFS prognostic factors.Cranial nerve involvement is 5-years OS prognostic factors.Multiple factors analysis showed that the cavernous sinus invaded and local cranial nerves invaded not independent prognostic factors.Conclusion MRI can show cavernous sinus and cranial nerves invaded in NPC,cavernous sinus violation and local cranial nerve invaded with the prognosis,but is not an independent prognostic factor.