CAJ | 학술논문

目的评价单纯放疗老年鼻咽癌患者的远期疗效及不良反应.方法回顾分析本院1995-1998年间经病理证实的初治无远处转移、年龄≥65岁的老年鼻咽癌患者95例的临床资料,分析其远期生存率及不良反应.采用Kaplan-Meier法计算局部控制率和无远处转移生存率,Logrank法单因素预后分析,Cox模型多因素预后分析.结果随访率为98％.3、5、8年局部控制率和无远处转移生存率分别为89％、87％、84％和85％、79％、79％.急性不良反应主要为1、2级血液学反应(34例)、皮肤反应(61例)和口腔黏膜炎(63例)；晚期不良反应主要为听力下降(8％)、张口困难(10％)和颅神经损伤(5％).单因素分析结果显示影响局部控制率因素有放疗是否中断(χ2=7.45,P=0.006)、颈部淋巴结疗效(χ2 =4.17,P=0.041),影响无远处转移生存率有T分期(χ2=4.16,p=0.032)、N分期(χ2 =4.66,P=0.031)、放疗是否中断(χ2=9.42,P=0.002)；多因素分析结果显示影响局部控制率因素有放疗是否中断(χ2 =6.19,P=0.013)和颈部淋巴结疗效(χ2=12.26,P=0.002),影响无远处转移生存率因素有N分期(χ2 =15.06,P=0.000)和放疗是否中断(χ2=21.62,P=0.000).结论老年鼻咽癌患者行单纯常规放疗即可取得较好疗效且不良反应较轻；N分期早、放疗顺利完成和颈部淋巴结完全缓解的远期预后良好.
목적 평개단순방료노년비인암환자적원기료효급불량반응.방법 회고분석본원1995-1998년간경병리증실적초치무원처전이、년령≥65세적노년비인암환자95례적림상자료,분석기원기생존솔급불량반응.채용Kaplan-Meier법계산국부공제솔화무원처전이생존솔,Logrank법단인소예후분석,Cox모형다인소예후분석.결과 수방솔위98％.3、5、8년국부공제솔화무원처전이생존솔분별위89％、87％、84％화85％、79％、79％.급성불량반응주요위1、2급혈액학반응(34례)、피부반응(61례)화구강점막염(63례)；만기불량반응주요위은력하강(8％)、장구곤난(10％)화로신경손상(5％).단인소분석결과현시영향국부공제솔인소유방료시부중단(χ2=7.45,P=0.006)、경부림파결료효(χ2 =4.17,P=0.041),영향무원처전이생존솔유T분기(χ2=4.16,p=0.032)、N분기(χ2 =4.66,P=0.031)、방료시부중단(χ2=9.42,P=0.002)；다인소분석결과현시영향국부공제솔인소유방료시부중단(χ2 =6.19,P=0.013)화경부림파결료효(χ2=12.26,P=0.002),영향무원처전이생존솔인소유N분기(χ2 =15.06,P=0.000)화방료시부중단(χ2=21.62,P=0.000).결론 노년비인암환자행단순상규방료즉가취득교호료효차불량반응교경；N분기조、방료순리완성화경부림파결완전완해적원기예후량호.
Objective To evaluate the outcomes and toxicities of elderly nasopharyngeal carcinoma (NPC) treated with conventional radiotherapy alone.Methods From January 1995 to December 1998,95 newly diagnosed nasopharyngeai carcinoma with age ≥65 years treated in our hospital.The clinical data were analyzed retrospectively.Kaplan-Meier method was used for analysis of local-regional control survival and distant metastasis-free survival. The Logrank test was used for univariate prognostic analysis and Cox regression was used for multivariable prognostic analysis.Results The follow-up rate was 98％.The 3-,5- and 8-year local-regional control (LRC) and distant metastasis-free survival (DMFS) rates were 89％,87％,84％ and 85％,79％,79％,respectively. The most common acute toxicities were grade1-2 leukopenia (36％),skin reaction (64％) and mucositis (66％).The most frequent late toxicities were hearing impairment (8％),trismus ( 10％ ) and radiation-induced cranial neuropathy (5％).In univariate analysis,interruption of radiotherapy ( χ2 =7.45,P =0.006 ) and regional neck lymph nodes response (χ2 =4.17,P=0.041 ) was the prognostic factors for LRC,T stage (χ2 =4.16,P=0.032),N stage ( χ2 =4.66,P =0.031 ) and interruption of radiotherapy ( χ2 =9.42,P =0.002 ) was the prognostic factors for DMFS. In multivariable analysis,interruption of radiotherapy and the regional neck lymph nodes response were the prognostic factors for LRC (χ2=6.19,P=0.013 and χ2=12.16,P=0.002;respectively),N stage and radiotherapy interruption were prognostic factors for DMFS.(χ2=15.06,P =0.000 and χ2 =21.62,P =0.000 ; respectively ).Conclusions Conventional radiotherapy alone for elder NPC can produce satisfactory results with acceptable treatment-relative toxicities.Our experience showed that the early N stage,without radiotherapy interruption and good regional lymph nodes response had a good longterm prognosis.