鼻咽癌放疗后颈淋巴结失败挽救手术的疗效和预后因素

摘要

目的：研究鼻咽癌放疗后颈部淋巴结残留或复发行挽救手术治疗的疗效及影响预后的因素，探讨其合理的治疗方法。方法：回顾性分析2001-2009年行挽救手术治疗的鼻咽癌放疗后颈部淋巴失败患者39例的临床资料。重新评价手术标本的病理参数及肿瘤TNM分期。分析其总生存率和颈部控制情况及相关临床病理因素。结果：全组3年、5年总生存率（ OS）为63.6％、53.4％，3年、5年颈部控制率（ NCR ）为77.1％、70.0％。鼻咽癌初始治疗采用单纯放疗组OS优于同步放化疗组；rN1组OS和NCR均优于rN2/3组。复发N分期是影响OS和NCR的唯一独立因素。结论：颈清扫术是鼻咽癌放疗后颈部淋巴结失败的有效治疗手段。初始治疗方法、复发N分期与生存预后相关。复发N分期是预后的独立因素。%Objective:To reveal the treatment outcome and prognostic predictors of salvage surgery for residual or recurrent cervical metastasis of nasopharyngeal carcinoma after radiotherapy,as well as to explore an optimal treatment modality. Methods:Clinical data of 39 patients who underwent salvage neck dissections for their residual or recurrent cervical metastases after radiotherapy for nasopharyngeal carcinoma were retrospectively analyzed. Pathological param-eters of the surgical specimen and TNM classification were re -evaluated. Overall survival( OS),neck control rate (NCR),and their correlated patho-clinical factors were analyzed. Results:The 3-year and 5-year OS was 63. 6%and 53. 4%,respectively,the 3 -year and 5 -year NCR was 77. 1% and 70. 0%,respectively. Survival status was better in patients who underwent single radiotherapy as initial treatment for nasopharyngeal carcinoma than in patients who underwent concomitant chemo-radiotherapy. OS and NCR of the rN1 group were better than that of the rN2/3 group. rN stage was the only independent predictor for both OS and NCR. Conclusion:Neck dissection is an effica-cious salvage procedure for neck failure of nasopharyngeal carcinoma after radiotherapy. Initial treatment modality and rN stage were associated with survival in univariate analysis. rN stage was the only independent prognostic factor.