初诊为M1期鼻咽癌的预后因素研究

发布时间：2018-08-06 10:19

【摘要】：背景： 鼻咽癌是在我国南方尤其是广东省最常见的恶性肿瘤之一，发病率达到10万分之30至50，位居世界之首。鼻咽癌95％以上属于低分化鳞癌，恶性程度高，生长快．易出现远处转移,远处转移是鼻咽癌致死的最重要的原因，同时也是影响生存的最重要因素。初诊为M1期的病人较放疗后出现远处转移者预后更差。对于初诊时为M1期的病人目前的治疗尚无一致意见。关于初诊M1期的鼻咽癌的预后因素分析的报道也甚少，且这些报道中分析的预后因素各有不同。 研究目的： 通过关于初诊为M1期的鼻咽病人资料的回顾性分析，找寻并分析对其预后影响的相关因素。研究方法： 从2001年1月至2007年12月，92例资料完整的初治时确诊为远处转移的鼻咽癌病人在广州医学院附属肿瘤医院住院治疗，其中75例男性，17例女性，中位年龄为47岁（14-71岁），骨转移最常见，单纯骨转移39例，单纯肺转移13例，单纯肝转移11例，其他器官2例，多器官转移27例，68例病人接受了原发鼻咽病灶放疗及全身化疗，24例仅接受全身化疗。接受原发灶放疗的病人中，，总的鼻咽病灶外照射剂量为50-72Gy(中位剂量66Gy)，颈部剂量50～66Gy(中位剂量56Gy)。全组病人接受化疗共371程，主要以顺铂为基础的方案进行，化疗1～12个周期，其中化疗4个疗程46例，化疗≥4个疗程46例，采用用Kaplan-Meier法计算生存率，log-rank检验各组生存率，并用Cox逐步回归模型进行多因素分析,分析的因素包括：性别、年龄（大于等于或小于45岁）、N分期、T分期、是否多脏器转移、单纯肝、骨、肺转移、是否原发灶放疗、化疗程数（大于等于4程或者小于4程）。 研究结果： 全组患者1、2、3生存率分别为68.4％、35.8％、15.2％,中位生存期为17(1～65)个月。单因素分析结果提示N分期（P=0.004），多脏器转移（P=0.000）、原发灶放疗（P=0.000)、化疗程数(P=0.022)是初诊转移性鼻咽癌预后的影响因素。多因素分析结果提示N分期（P=0.006）、多器官转移（P=0.005）、化疗程数(P=0.015)和原发灶放疗（P=0.018）是影响初诊时已有转移性鼻咽癌预后的独立因素。 结论： 通过对初诊为M1期的鼻咽癌的患者资料行单因素及多因素分析，结果提示N分期、多脏器转移、原发灶放疗及化疗程数是独立预后因素。从上述资料看，对于初诊为M1期的鼻咽癌病人，予以原发灶放疗联合大于4程的化疗可改善生存，这样的结果还待大宗的随机对照临床实验来加以验证。
[Abstract]:Background: nasopharyngeal carcinoma (NPC) is one of the most common malignant tumors in southern China, especially in Guangdong Province. More than 95% of nasopharyngeal carcinoma belongs to poorly differentiated squamous cell carcinoma with high malignancy and rapid growth. Distant metastasis is the most important cause of death and the most important factor affecting the survival of nasopharyngeal carcinoma. The prognosis of M 1 patients was worse than that of patients with distant metastasis after radiotherapy. There is no consensus on current treatment for first-diagnosed M 1 patients. There are few reports on prognostic factors analysis of nasopharyngeal carcinoma (NPC) in newly diagnosed M1 stage, and the prognostic factors are different in these reports. Objective: to study the prognostic factors of nasopharyngeal patients in M1 stage by retrospective analysis. Methods: from January 2001 to December 2007, 92 patients with nasopharyngeal carcinoma diagnosed as distant metastasis were admitted to the affiliated Cancer Hospital of Guangzhou Medical College, including 75 males and 17 females. The median age was 47 years (14-71 years). Bone metastasis was most common in 39 cases of simple bone metastasis, 13 cases of simple lung metastasis, 11 cases of simple liver metastasis, and 2 cases of other organs. Twenty-seven patients with multiple organ metastasis received primary nasopharyngeal focus radiotherapy and systemic chemotherapy. 24 patients received systemic chemotherapy only. The total external dose of nasopharyngeal focus was 50-72Gy (median dose 66Gy) and cervical dose of 50~66Gy (median dose 56Gy). A total of 371 courses of chemotherapy were performed in the whole group. The chemotherapy was based on cisplatin regimen. There were 46 patients with 4 courses of chemotherapy and 46 patients with chemotherapy 鈮

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