鼻咽癌放疗后颈淋巴结复发的治疗及预后分析

摘要

目的 比较鼻咽癌放疗后颈淋巴结复发不同治疗方法的疗效,探讨可能影响预后的因素.方法 回顾性分析广西壮族自治区人民医院耳鼻咽喉头颈肿瘤科79例鼻咽癌患者放疗后经病理诊断为颈部淋巴结复发的临床资料.按患者性别、年龄、治疗结束到复发的时间间隔、颈部复发灶与原肿块的位置关系、rN分期、治疗方式分组,了解不同因素对于患者预后的影响,单因素生存分析采用log-rank检验,多因素生存分析采用Cox比例风险模型,并对有预后意义的指标做Kaplan-Meier生存曲线.结果 鼻咽癌患者的颈部淋巴结中位复发时间为26个月;颈淋巴结复发再治疗后1年生存率为77.9％,3年生存率为53.4％,5年生存率为39.7％;单因素分析预后与年龄、治疗结束到复发的时间间隔、复发灶与原肿块的位置关系、rN分期、治疗方式有关,多因素分析其预后同年龄、rN分期、治疗方法及颈部复发灶与原肿块的位置关系有关,以手术为主的治疗效果优于以放疗为主的治疗方式.结论 鼻咽癌放疗后颈淋巴结复发手术治疗的疗效优于放疗,年龄≤45岁、rN早期及复发灶位于原肿块中心区域的患者预后较好.%Objective To evaluate the efficacies of different treatments for recurrent cervical lymph nodes and the factors contributing to prognosis in patients with nasopharyngeal carcinoma after radiotherapy.Methods Clinical data of 79 patients with nasopharyngeal carcinoma after radiotherapy were retrospectively analyzed, and all cases were diagnosed as having recurrent cervical lymph nodes by pathological examination.The factors including sex, age, the interval between completion of radiotherapy and recurrence, rN stage, treatment methods, and the location relationship between recurrent lesion and primary tumor in the neck were analyzed for prognosis.Kaplan-Meier curves, Log-rank test and Cox's proportional hazards regression mode were used in the statistical analysis.Results The median recurrence time was 26 months, and the 1-, 3-and 5-year overall survival rates were 77.9％ , 53.4％ and 39.7％.Cox's proportional hazards regression mode analysis indicated that age, rN stage, treatment methods, and the location relationship between recurrent lesion and primary tumor were significantly prognostic factors.Conclusions Neck dissection is superior to re-radiotherapy in treatment of recurrent cervical lymph nodes in nasopharyngeal carcinoma after radiotherapy.The patients younger than 45 years old, in early rN stage and for recurrence in the center region of primary tumor have a better prognosis.