CAJ | 학술논문

目的探讨临床转移特征对转移性鼻咽癌的预后影响,为鼻咽癌远处转移(M1期)的多层次分期细化提供帮助.方法 1016例鼻咽癌远处转移患者根据转移时序性(同时性和异时性)、转移器官类别(肺、骨、肝)、转移器官数目(单个、多发)和转移灶数目(孤立、多发)进行分组,分析其生存情况.结果全组鼻咽癌最常见的远处转移部位分别为骨(542例,53.3％)、肺(420例,41.3％)、肝(302例,29.7％).孤立性转移164例.同时性转移376例,异时性转移640例.全组鼻咽癌远处转移患者的转移后中位生存时间为30.8个月,其中同时性转移和异时性转移患者的转移后中位生存时间分别为23.3个月和36.7个月.同时性转移的鼻咽癌患者1、3、5年生存率分别为74.2％、27.6％和18.5％,异时性转移的鼻咽癌患者1、3、5年生存率分别为88.1％、49.6％和28.6％,差异均有统计学意义(均P＜0.001).多因素分析结果显示,转移灶数目、转移器官类别和初诊时N分期是影响鼻咽癌异时性远处转移患者预后的独立因素(均P ＜0.05).结论针对鼻咽癌远处转移的不同情况,建立鼻咽癌远处转移多层次分期的理论,根据其预期生存时间选择合适的个体化治疗方案,提高鼻咽癌的诊治水平.
목적 탐토림상전이특정대전이성비인암적예후영향,위비인암원처전이(M1기)적다층차분기세화제공방조.방법 1016례비인암원처전이환자근거전이시서성(동시성화이시성)、전이기관유별(폐、골、간)、전이기관수목(단개、다발)화전이조수목(고립、다발)진행분조,분석기생존정황.결과 전조비인암최상견적원처전이부위분별위골(542례,53.3％)、폐(420례,41.3％)、간(302례,29.7％).고립성전이164례.동시성전이376례,이시성전이640례.전조비인암원처전이환자적전이후중위생존시간위30.8개월,기중동시성전이화이시성전이환자적전이후중위생존시간분별위23.3개월화36.7개월.동시성전이적비인암환자1、3、5년생존솔분별위74.2％、27.6％화18.5％,이시성전이적비인암환자1、3、5년생존솔분별위88.1％、49.6％화28.6％,차이균유통계학의의(균P＜0.001).다인소분석결과현시,전이조수목、전이기관유별화초진시N분기시영향비인암이시성원처전이환자예후적독립인소(균P ＜0.05).결론 침대비인암원처전이적불동정황,건립비인암원처전이다층차분기적이론,근거기예기생존시간선택합괄적개체화치료방안,제고비인암적진치수평.
Objective To investigate the prognostic factors for nasopharyngeal carcinoma (NPC)with different metastatic status,and to improve the NPC management by multi-level refinement and stratification of M1 stage distant metastases.Methods Clinicopathological data of 1016 NPC patients with distant metastases were retrospectively reviewed.The M1 stage distant metastases were subdivided into synchronous or metachronous metastases,metastatic sites (lung,bone,liver),number of metastatic organs (solitary,multiple) and number of metastases (solitary,multiple) subgroups to analyze the prognosis and survival of the patients.Results The most frequently involved metastatic sites were bone (542,53.3％),lung (420,41.3％) and liver (302,29.7％).There were solitary metastatic lesions in 164 patients (16.2％),synchronous metastases in 376 cases and metachronous metastases in 640 cases.The median overall survival of the whole group of 1016 NPC patients was 30.8 months since the time of diagnosis of metastasis.For the 376 patients in the synchronous metastasis group,the median survival was 23.3 months and the 1-,3-and 5-year overall survival rates were 74.2％,27.6％ and 18.5％,respectively.For the 640 patients in the metachronous metastases group,the median survival was 36.7 months,and the 1-,3-and 5-year overall survival rates were 88.1％,49.6％ and 28.6％,respectively,with a significant difference between the two groups (all P ＜ 0.001).Cox multivariate analysis indicated that the number of metastatic lesions,different metastatic sites and N stage at initial diagnosis were independent prognostic factors for patients with metachronous metastases (P ＜ 0.05).Conclusions A theory of detailed multi-level metastasis (M1) stratification aiming at different distant metastasis status for nasopharyngeal carcinoma is proposed.To take appropriate individualized treatment scheme according to the prognosis and expected survival should be helpful to improving the diagnosis and treatment of nasopharyngeal cancer.