78例海绵窦受侵的鼻咽癌临床及预后因素分析

发布时间：2019-01-01 20:07

【摘要】：目的：通过回顾性分析78例诊断海绵窦受侵的鼻咽癌患者的资料,探讨鼻咽癌海绵窦受侵的临床特点和相关预后因素。方法：收集广西医科大学附属肿瘤医院2005年8月至2006年12月收治的诊断海绵窦受侵的经病理组织学证实的鼻咽癌78例患者病历资料,所有患者治疗前均行详细的体格检查、鼻咽部+颈部CT或(和)MRI检查、鼻咽纤维镜检查、鼻咽肿物活检及病理检查及其他相关检查。阅读影像学资料,病人行放化疗,随访至2012年1月,分析鼻咽癌海绵窦受侵的临床及影像学特点,海绵窦受侵的发生率,总缓解率、生存率、远处转移率以及预后因素。结果： 1.547例鼻咽癌患者中,初筛诊断海绵窦受侵病例98例,鼻咽癌海绵窦受侵的发生率为17.9%。 2.78例患者中伴头痛症状者61例(78.21%),全部为与受累海绵窦同侧性头痛,近70%头痛患者同时合并颅底骨和前组颅神经损伤。颅底骨破坏72例(92.31%)。3个部位以上的广泛骨破坏45例(62.50%)。前组颅神经损害49例(62.82%)。 3.受侵海绵窦可从MRI检测出64侧显示28侧(43.75%)表现为海绵窦增大并有异常强化,22侧(34.38%)表现为海绵窦壁增厚和(或)海绵窦内血管、神经结构紊乱或模糊不清,14侧(21.88%)表现为在海绵窦区局部形成肿块。 4.全组患者1、3、5年生存率分别为81%、51%、24%,总缓解率RR为34.62%,全组远处转移率19.23%。 5.经单因素及多因素分析结果显示脑神经损伤条数、放疗剂量、有无副鼻窦受侵为影响患者的OS(总生存率)的独立预后因素(P0.05)。结论： 1.本组鼻咽癌患者海绵窦受侵发生率为17.9%,低于国内外其他文献报道。 2.海绵窦受侵的鼻咽癌患者中头痛症状同时伴有颅底骨和前组脑神经受累比例近69.39%,这一特点有助于在临床上提高检出海绵窦侵犯。 3.脑神经损伤条数、放疗剂量、有无副鼻窦受侵是侵犯海绵窦的鼻咽癌的独立预后因素。
[Abstract]:Objective: to analyze retrospectively the clinical features and prognostic factors of 78 cases of nasopharyngeal carcinoma (NPC) with cavernous sinus invasion. Methods: the medical records of 78 patients with nasopharyngeal carcinoma confirmed by histopathology were collected from August 2005 to December 2006 in Cancer Hospital affiliated to Guangxi Medical University. Nasopharyngeal neck CT or / and MRI, nasopharyngeal fiberoptic examination, nasopharyngeal mass biopsy, pathological examination and other related examinations. The clinical and imaging features of cavernous sinus invasion of nasopharyngeal carcinoma (NPC), the incidence of cavernous sinus invasion, total remission rate, survival rate, distant metastasis rate and prognostic factors were analyzed. Results: among 1.547 patients with nasopharyngeal carcinoma, 98 cases were diagnosed as cavernous sinus invasion. The incidence of cavernous sinus invasion in nasopharyngeal carcinoma was 17.9%. 2.Sixty-one (78.21%) of 78 patients had headache symptoms, all of which were ipsilateral headache with the involved cavernous sinus, and nearly 70% of the headache patients were accompanied with cranial base bone and anterior cranial nerve injury at the same time. There were 72 cases (92.31%) of skull base bone destruction and 45 cases (62.50%) of extensive bone destruction above 3 sites. There were 49 cases (62.82%) with cranial nerve injury in anterior group. 3. 64 sides (43.75%) showed enlargement and abnormal enhancement of cavernous sinus, 22 sides (34.38%) showed thickening of cavernous sinus wall and / or vessels in cavernous sinus. 14 sides (21.88%) showed lumps in cavernous sinus region. 4. The 3- and 5-year survival rates of the patients were 81 and 51, respectively. The total remission rate (RR) was 34.62, and the distant metastasis rate was 19.23 in the whole group. 5. The results of univariate and multivariate analysis showed that the number of cerebral nerve injury, the dose of radiotherapy and the presence of paranasal sinus invasion were independent prognostic factors of OS (P05). Conclusion: 1. The incidence of cavernous sinus invasion in patients with nasopharyngeal carcinoma was 17.9, which was lower than that reported in other literatures at home and abroad. 2. The incidence of headache associated with skull base and anterior cranial nerve involvement in patients with nasopharyngeal carcinoma with cavernous sinus invasion is nearly 69.39. This feature is helpful to improve the clinical detection of cavernous sinus invasion. 3. The independent prognostic factors of nasopharyngeal carcinoma invading cavernous sinus were the number of brain nerve injury, the dose of radiotherapy and the invasion of paranasal sinus.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R739.63

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