CAJ | 학술논문

目的探讨MRI发现的颅神经侵犯在鼻咽癌分期中意义.方法回顾分析2005-2007年间基于MRI诊断的816例初诊鼻咽癌患者资料.T4期颅神经组定义为MRI上伴有颅神经侵犯但体检无颅神经麻痹且无其他T4期解剖结构侵犯者,余T4期患者定义为T4期其他组.临床分期中Ⅳa期颅神经组定义为T4期颅神经组N0～2期,余Ⅳa期患者定义为Ⅳa期其他组.比较T分期、临床分期各亚组疗后生存情况.Kaplan-Meier法计算生存率并用Logrank法检验.结果随访率为94.1％.鼻咽癌颅神经侵犯率为38.5％.T分期中T2、T3、T4期颅神经组的无局部复发生存、无远处转移生存以及疾病相关生存曲线重合,但与T4期其他组能拉开.临床分期中Ⅳa期颅神经组5年疾病相关生存率与Ⅲ期的相似(x2 =0.18,P=0.674),而与Ⅱ、Ⅳa期其他组不同(x2=5.86、7.23,P=0.015、0.007).结论 MRI诊断颅神经侵犯的T4期、Ⅳa期患者,若无合并其他T4期解剖结构受累则无局部复发、无远处转移生存率与T2、T3期相似,疾病相关生存率与Ⅲ期相似,预后较T4期其他组及Ⅳa期其他组好；若将这部分患者归为T4期、Ⅳa期将导致患者接受适合于Ⅳ期病例的治疗方案从而引起过度治疗的可能.
목적 탐토MRI발현적로신경침범재비인암분기중의의.방법 회고분석2005-2007년간기우MRI진단적816례초진비인암환자자료.T4기로신경조정의위MRI상반유로신경침범단체검무로신경마비차무기타T4기해부결구침범자,여T4기환자정의위T4기기타조.림상분기중Ⅳa기로신경조정의위T4기로신경조N0～2기,여Ⅳa기환자정의위Ⅳa기기타조.비교T분기、림상분기각아조료후생존정황.Kaplan-Meier법계산생존솔병용Logrank법검험.결과 수방솔위94.1％.비인암로신경침범솔위38.5％.T분기중T2、T3、T4기로신경조적무국부복발생존、무원처전이생존이급질병상관생존곡선중합,단여T4기기타조능랍개.림상분기중Ⅳa기로신경조5년질병상관생존솔여Ⅲ기적상사(x2 =0.18,P=0.674),이여Ⅱ、Ⅳa기기타조불동(x2=5.86、7.23,P=0.015、0.007).결론 MRI진단로신경침범적T4기、Ⅳa기환자,약무합병기타T4기해부결구수루칙무국부복발、무원처전이생존솔여T2、T3기상사,질병상관생존솔여Ⅲ기상사,예후교T4기기타조급Ⅳa기기타조호；약장저부분환자귀위T4기、Ⅳa기장도치환자접수괄합우Ⅳ기병례적치료방안종이인기과도치료적가능.
Objective To identify the value of cranial nerve involvement found on magnetic resonance imaging (MRI) in staging of nasopharyngeal carcinoma (NPC).Methods A retrospective analysis was performed on the clinical data of 816 patients with NPC initially diagnosed by MRI during 2005 -2007.The patients with stage T4 NPC were divided into cranial nerve subgroup,which was defined as patients who had cranial nerve involvement on MRI,but without cranial nerve palsy or other T4-related anatomical structure involvement,and other subgroup,which was defined as other patients with stage T4 NPC ;the patients with stage Ⅳ a NPC were divided into cranial nerve subgroup,which was defined as patients with T4N0-2 NPC who were classified into the cranial nerve subgroup of patients with stage T4 NPC,and other subgroup,which was defined as other patients with stage Ⅳa NPC.The survivals of the subgroups were compared.The Kaplan-Meier method was used for calculating survival rates,and the survival differences were analyzed by the log-rank test.Results The follow-up rate was 94.1％.Cranial nerve involvement was seen in 38.5％ of all patients.Local recurrence-free survival,distant metastasis-free survival,and disease-related survival curves of patients with stage T2 and T3 NPC and the cranial nerve subgroup of patients with stage T4 NPC coincided,but they were separated from the curves of the other subgroup of patients with stage T4 NPC.There was no significant difference in 5-year disease-related survival rate between the cranial nerve subgroup of patients with stage Ⅳa NPC and the patients with stage Ⅲ NPC (x2 =0.18,P =0.674),but significant differences were found when this subgroup was compared with patients with stage Ⅱ NPC (x2 =5.86,P =0.015) and the other subgroup of patients with stage Ⅳa NPC (x2 =7.23,P =0.007).Conclusions The patients with stage T4/Ⅳa NPC who have cranial nerve involvement on MRI,but without other T4-related anatomical structure involvement,have similar local recurrence-free survival rate and distant metastasis-free survival rate as those with stage T2 and T3 NPC and have a similar disease-related survival rate as those with stage Ⅲ NPC,and their prognosis is better than that of the other subgroup of patients with stage T4/Ⅳa NPC.It may lead to overtreatment for patients if they are classified as stage T4/Ⅳa and receive the treatment regimen for stage Ⅳ NPC.