CAJ | 학술논문

[目的]探讨基于磁共振成像(MRI)的鼻咽癌颅底骨质破坏的预后价值.[方法]于2003年至2004年共924例经病理等确诊为无远处转移的鼻咽初治病人纳入本研究,所有的病人均在治疗前进行了MRI检查并以放疗为首要治疗手段.我们回顾性的分析了相应的MRI及病历资料.所有的924例病人、MRI证实有颅底骨质破坏的病人、315例乃分期的的病人及227例T2分期的病人被分别挑选出来进行预后分析.分期依据美国癌症分期联合委员会(AJCC)第六版鼻咽癌分期标准.[结果]MRI下颅底骨质破坏的发生率约为55.4%.颅底骨质破坏并非影响鼻咽癌患者总生存(OS)和无远处转移生存(DMFS)的独立预后因素,但有可能是影响无局部复发生存(LRFS)的独立预后因素(P=0.068).对于512例合并颅底骨质破坏的患者及315例T3分期的患者,根据受侵部位进行的颅底骨质破坏分级是影响其OS(P=0.002及P=0.005)及DMFS(P值均为0.001)的独立预后因素.MRI下严重级别的颅底骨质破坏是影响鼻叫癌患者OS及DMFS的独立预后因素(P值均小于0.001).合并轻度级别颅底骨质破坏的T3分期患者与T2a分期的患者在预后方面(OS、LRFS及DMFS)的差异没有统计学意义.[结论]MRI下的颅底骨质破坏并非鼻咽癌患者的独立预后因素;然而,根据受侵部位的严重级别的颅底骨质破坏具有阳性的预后价值.
[목적]탐토기우자공진성상(MRI)적비인암로저골질파배적예후개치.[방법]우2003년지2004년공924례경병리등학진위무원처전이적비인초치병인납입본연구,소유적병인균재치료전진행료MRI검사병이방료위수요치료수단.아문회고성적분석료상응적MRI급병력자료.소유적924례병인、MRI증실유로저골질파배적병인、315례내분기적적병인급227례T2분기적병인피분별도선출래진행예후분석.분기의거미국암증분기연합위원회(AJCC)제륙판비인암분기표준.[결과]MRI하로저골질파배적발생솔약위55.4%.로저골질파배병비영향비인암환자총생존(OS)화무원처전이생존(DMFS)적독립예후인소,단유가능시영향무국부복발생존(LRFS)적독립예후인소(P=0.068).대우512례합병로저골질파배적환자급315례T3분기적환자,근거수침부위진행적로저골질파배분급시영향기OS(P=0.002급P=0.005)급DMFS(P치균위0.001)적독립예후인소.MRI하엄중급별적로저골질파배시영향비규암환자OS급DMFS적독립예후인소(P치균소우0.001).합병경도급별로저골질파배적T3분기환자여T2a분기적환자재예후방면(OS、LRFS급DMFS)적차이몰유통계학의의.[결론]MRI하적로저골질파배병비비인암환자적독립예후인소;연이,근거수침부위적엄중급별적로저골질파배구유양성적예후개치.
[Objective]To evaluate the prognostic value of skull-base invasion of nasopharyngeal carcinoma(NPC)based on magnetic resonance imaging(MRI).[Methods]A total of 924 patients who were diagnosed with NPC between 2003 and 2004,had undergone MRI scan and received mdiothempy as their primary treatment,and had no distant metastasis were included in this study.MRI images and medical records were analyzed retrospectively.All the 924 eases.patients who developed skull-base invasions based on MRI,315 patients with T3 disease and 227 patients with T2 disease were selected for analysis.The staging was according to the sixth edition of the American Joint Commission on Cancer(AJCC)staging system.[Results]Incidence of skullbase invasion according to MRI was 55.4%.Of 924 cases.skull-base invasion on MRI was not an independent prognostic factor for overall survival(OS)and distant metastasis-free survival(DMFS),but was a marginally significant independent prognostic factor for local relapse-free survival(LRFS),P=0.068.Grading of MRI-detected skull-base erosion according to the site of invasion was an independent prognostic factor for OS(P=0.002 and P=0.005)and DMFS(P=0.001 for both)in the 512 patients with skull-base invasions and 315 patients with T3 disease.Severe-grade of skull-base invasion on MRI was an independent prognostic factor for OS and DMFS in the 924 patients(P ＜ 0.001 for both).No significant differences were observed on OS,LRFS,and DMFS between T2a patients and T3 patients with low-grade of MRI-deteeted skull-base involvement.[Conclusions]Skull-base invasion based on MRI is not an independent prognostic factor for NPC.However,severe-grade of invasion according to the site of involvement has positive prognostic value.