鼻咽癌患者根治性放化疗后远处转移、预后生存调查及影响因素分析

Investigation of distant metastasis,prognosis and survival of patients with nasopharyngeal carcinoma after radical chemoradiotherapy and analysis of influencing factors

目的:分析根治性放疗治疗后远处转移鼻咽癌患者预后生存情况及预测因子。方法:回顾性分析2015年3月至2020年10月本院收治的108例鼻咽癌患者的临床资料。所有患者在初诊时均予以根治性放疗和化疗。对患者随访资料进行记录,统计3年内远处转移及生存情况,并分析影响患者预后生存的危险因子。结果:截止随访结束,108例患者95(87.96%)例患者发生远处转移,中位转移时间为14.42±2.62 m,以骨转移、肺转移及纵膈淋巴结转移处多见。108例患者中位生存时间为13.41±4.81 m,生存率为26.31%。95例远处转移患者中,4例患者仅进行营养干预;6例患者采取转移灶姑息放疗;48例予以单纯全身化疗;37例予以全身辅助化疗+局部姑息放疗。初诊时N分期、转移后化疗周数及转移部位为影响经根治性放疗治疗后远处转移鼻咽癌患者预后生存的独立危险因素(P<0.05)。结论:初诊时N分期、转移后化疗周数及转移部位均为经根治性放疗治疗后远处转移鼻咽癌患者预后生存的预测因子,对合并危险因素的高危患者进行合理干预有利于提升治疗后远处转移患者生存率。

Objective:To analyze the prognosis and predictors of survival in patients with distant metastatic nasopharyngeal carcinoma after radical radiotherapy.Methods:The clinical data of 108 patients with nasopharyngeal carcinoma admitted to our hospital from March 2015 to October 2020 were retrospectively analyzed.All patients were treated with radical radiotherapy and chemotherapy at initial diagnosis.Follow-up data of patients were recorded,remote metastasis and survival in 3 years were analyzed,and the risk factors affecting the prognosis and survival of patients were analyzed.Results:Up to the end of follow-up,95(87.96%)of 108 patients had distant metastasis,the median metastasis time was 14.42±2.62 months,and the most common metastatic sites were bone metastasis,lung metastasis and mediastinal lymph node metastasis.The median survival time of 108 patients was 13.41±4.81 months,and the survival rate was 26.31%.Of the 95 patients with distant metastasis,4 patients only received nutritional intervention.6 patients received metastatic palliative radiotherapy;48 cases received systemic chemotherapy alone;37 cases received systemic adjuvant chemotherapy and local palliative radiotherapy.N stage at initial diagnosis,weeks of chemotherapy after metastasis and site of metastasis were independent risk factors for survival of patients with distant metastatic nasopharyngeal carcinoma after radical radiotherapy(P<0.05).Conclusion:The N stage at initial diagnosis,the number of weeks of chemotherapy after metastasis and the site of metastasis are all predictors of prognosis and survival of patients with distant metastasis of nasopharyngeal carcinoma after radical radiotherapy.Reasonable intervention of high-risk patients with combined risk factors is conducive to improving the survival rate of patients with distant metastasis after treatment.