83例鼻咽癌放射治疗后颈淋巴结转移复发的治疗

The surgical treatment of failure in cervical lymph nodes after radiotherapy for nasopharyngeal carcinoma:an analysis of 83 patients

目的 探讨颈淋巴结清扫术治疗鼻咽癌放射治疗后颈部淋巴结转移未控或复发患者的疗效。方法 回顾性分析因鼻咽癌放射治疗后颈淋巴结转移未控或复发行颈清扫术的 83例患者 ,其中rN1期 5 4例 ,rN2期 19例 ,rN3期 10例。按年龄、性别、放射治疗结束至手术之日的间隔时间、rN分期、是否行术后放射治疗、是否有软组织侵犯、病理检测阳性淋巴结个数和各组淋巴结阳性情况分为2个组。生存率分析采用Kaplan Meier法 ,差异显著性检验采用Logrank法 ,多因素分析采用Cox模型。结果 1、3、5年总生存率分别为 80 .7%、4 7.1%、34.9% ,其预后因素与有无软组织侵犯、放射治疗结束至手术之日间隔时间有关 ,术后放射治疗可提高生存率。结论 鼻咽癌放射治疗后颈部复发或未控的淋巴结的治疗可采用根治性颈淋巴结清扫术 ,对有包膜浸润和 (或 )周围软组织侵犯的患者可补充放射治疗。

Objective To analyze the results of neck dissection in patients who failed in cervical lymph nodes after radiotherapy for nasopharyngeal carcinoma.Methods Eighty-three patients who received neck dissection due to lymph node persistence or recurrence after definitive radiotherapy were analyzed retrospectively according to the following relevant factors: age, sex, the interval between completion of radiotherapy and surgery, rN stage, postoperative radiotherapy given or not, the adjacent tissues involved or not and the number of positive nodes. Kaplan-Meier method, Log-rank method and Cox method were used in the statistical analysis.Results The 1-, 3- and 5-year overall survival rates were 80.7%, 47.1% and 34.9%. The interval between completion of radiotherapy and surgery, postoperative radiotherapy given or not, the adjacent tissues involved or not were significantly prognostic factors in statistic analysis. Conclusions Neck dissection can be applied in the management of cervical lymph node failure in nasopharyngeal carcinoma after radiotherapy. Postoperative radiotherapy should be considered in patients with capsular invasion and/or adjacent tissue involvement.