Objective:To investigate the prognosis of cervical and posterior to level V (PLV) lymph node metastasis and discuss further updates on neck levels and N stages for nasopharyngeal carcinoma (NPC). Methods:A total of 406 pathologically diagnosed NPC cases from December 2011 to June 2016 were retrospectively analyzed. SPSS 20.0 was used to analyze the prognosis of patients with cervi-cal and PLV lymph node metastasis. Results:In the 406 cases, the 5-year overall survival (OS), progression-free survival (PFS), local re-lapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were 75.0%, 63.4%, 87.2%, and 81.8%, respectively. The 3-year OS, PFS, LRFS, and DMFS of patients with node involvement of PLV were 51.5%, 22.7%, 90.0%, and 41.3%, respectively. For the N3 stage, the 3-year OS, PFS, LRFS, and DMFS with or without PLV involvement were 43.9%and 84.7%(P=0.002), 12.9%and 55.4%(P=0.006), 88.9%and 80.3%(P=0.649), and 33.0%and 85.9%(P<0.001), respectively. Univariate analysis showed that N stage was a prog-nostic factor for OS, PFS, and DMFS (P<0.05). Multivariate analysis demonstrated that PLV was an independent prognostic factor for DMFS (P<0.05). Conclusion:Patients with NPC with PLV node involvement exhibited poor prognosis and an increased risk of distant metastasis. Thus, PLV should be a new neck node level for head and neck tumors.%目的:回顾性分析鼻咽癌患者伴有颈部及Ⅴ区后缘间隙淋巴结转移的预后情况,为颈部淋巴结分区及鼻咽癌N分期的进一步修订提供参考.方法:选取2011年12月至2016年6月成都军区总医院经病理确诊为鼻咽癌的患者406例,分析伴有颈部及Ⅴ区后缘间隙淋巴结转移患者的预后情况.结果:406例患者的5年总生存率(overall survival,OS)、无进展生存率(progression-free survival,PFS)、无局部复发生存率(local relapse-free survival,LRFS)、无远处转移生存率(distant metastasis-free survival,DMFS)分别是75.0%、63.4%、87.2%和81.8%.伴有Ⅴ区后缘间隙淋巴结转移患者的3年OS、PFS、LRFS、DMFS分别是51.5%、22.7%、90.0%和41.3%.N3期患者伴或不伴有Ⅴ区后缘间隙淋巴结转移的3年OS、PFS、LRFS、DMFS分别是43.9%和84.7%(P=0.002)、12.9%和55.4%(P=0.006)、88.9%和80.3%(P=0.649)、33.0%和85.9%(P<0.001).单因素分析显示N分期是影响OS、PFS、DMFS的预后因素(P<0.05),多因素分析显示Ⅴ区后缘间隙淋巴结转移是影响DMFS的独立预后因素(P<0.05).结论:鼻咽癌患者伴有Ⅴ区后缘间隙淋巴结转移预后差,且该区淋巴结转移预示患者远处转移的风险增加.建议将Ⅴ区后缘间隙作为头颈部肿瘤一个新的颈部分区.
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