鼻咽癌咽后淋巴结转移对患者预后生存影响分析

The survival analysis of retropharyngeal lymph node metastasis in NPC

目的:探讨鼻咽癌(NPC)咽后淋巴结(RLN)转移对患者预后生存的影响。方法:搜集行鼻咽及颈部MRI检查的未经治疗并具有完整复查资料的新发NPC患者151例,总结NPC颈部淋巴结转移特点;将病例分为咽后淋巴结转移组(100例)与无咽后淋巴结转移组(51例)、单侧咽后淋巴结转移组(46例)与双侧咽后淋巴结转移组(54例),采用Kaplan-Meier计算两组病例1年、3年、5年的无局部复发生存率(LRFS)、无远处转移生存率(DMFS)及总生存率(OS)并行Log-rank检验。结果:NPC颈部淋巴结转移以Ⅱ区(96.69%)最常见,其后依次为Ⅲ区(75.50%)、咽后组(66.23%)、Ⅰ区(54.30%)、Ⅳ区(41.60%)、Ⅴ区(8.61%)、Ⅵ区(1.99%)。NPC咽后淋巴结转移组与无咽后淋巴结转移组的LRFS、DMFS及OS生存曲线相似,差异无统计学意义(P>0.05)。NPC单侧与双侧咽后淋巴结转移的DMFS(P=0.039)及OS(P=0.044)生存曲线明显分开,差异有统计学意义,而两组数据的LRFS生存曲线相似,差异无统计学意义(P>0.05)。结论:鼻咽癌单侧与双侧咽后淋巴结转移DMFS及OS生存曲线明显分开,双侧咽后淋巴结转移预后明显较单侧转移差,鼻咽癌单侧与双侧咽后淋巴结转移应该归为不同分期较为合理。

Objective:To investigate the prognosis value of retropharyngeal lymph node(RLN)metastasis in NPC.Methods:A group of 151 NPC without treatment were enrolled.All cases were divided into RLN metastasis group(100 cases)and non-RLN metastasis group(51 cases),the unilateral RLN metastasis group(46 cases)and the bilateral RLN metastasis group(54 cases).The local recurrence-free(LRFS),distant metastasis-free survival(DMFS)and overall survival(OS)were calculated by Kaplan-Meier method and conducted by Log-rank test.Results:The most common neck lymph node metastasis was theⅡarea(96.69%),followed byⅢarea(75.50%),RLN(66.23%),Ⅰarea(54.30%),Ⅳarea(41.60%),Ⅴarea(8.61%)andⅥarea(1.99%)in NPC.The survival curves of LRFS,DMFS and OS in the NPC RLN metastasis group and the non-RLN metastasis group were similar,and the difference was not statistically significant(P>0.05).The survival curves of DMFS(P=0.039)and OS(P=0.044)were significantly separated between the unilateral RLN metastasis group and the bilateral RLN metastasis group,there were significant difference between them,but the LRFS survival curves between the unilateral RLN metastasis group and the bilateral RLN metastasis group was similar,there was no significant difference(P>0.05).Conclusion:The survival curves of DMFS and OS were significantly separated in the unilateral and bilateral RLN metastases of NPC,the prognosis of NPC with bilateral RLN metastasis is significantly worse than unilateral RLN metastasis,unilateral and bilateral RLN metastases should be classified indifferent stages.