CAJ | 학술논문

目的探讨经鼻内镜下手术在复发性鼻咽癌治疗中的作用,并对其预后进行分析.方法回顾性分析2006年1月至2014年3月于复旦大学附属眼耳鼻喉科医院行内镜下手术切除的71例复发性鼻咽癌患者的资料.记录分析患者性别、年龄、T分期、肿瘤坏死、生存时间等临床病理特征.Kaplan-Meier法计算疾病总体生存率、疾病特异性生存率、无病生存率并绘制生存曲线.用Cox回归进行多因素分析,ROC曲线进行预后分析.结果 71例复发性鼻咽癌患者中男性53例,女性18例,男女比例为2.9:1;年龄27.0 ～ 80.0岁,中位数为51.0岁.以美国癌症联合委员会(AJCC)标准进行肿瘤分期(2010,第七版),rT1期27例、rT2期10例,rT3期19例,rT4期15例.所有患者均成功接受内镜下复发性鼻咽癌切除术,无1例行鼻外进路手术.平均手术时间为155 min.平均出血量为450 ml.3例患者术中输血.无严重术中、术后并发症,无手术死亡病例.术后随访时间为5～96个月.随访期间,48例存活,其中7例带瘤生存,1例出现肺部转移、1例颈部淋巴结转移.术后2年总体生存率和无瘤生存率分别为74.0％和60.5％.术后5年总体生存率和无瘤生存率分别为39.0％和31.9％.多因素分析表明,肿瘤坏死是影响患者生存的独立预后因素(P =0.001).结论经鼻内镜下手术是复发性鼻咽癌安全有效的治疗方式之一.
목적 탐토경비내경하수술재복발성비인암치료중적작용,병대기예후진행분석.방법 회고성분석2006년1월지2014년3월우복단대학부속안이비후과의원행내경하수술절제적71례복발성비인암환자적자료.기록분석환자성별、년령、T분기、종류배사、생존시간등림상병리특정.Kaplan-Meier법계산질병총체생존솔、질병특이성생존솔、무병생존솔병회제생존곡선.용Cox회귀진행다인소분석,ROC곡선진행예후분석.결과 71례복발성비인암환자중남성53례,녀성18례,남녀비례위2.9:1;년령27.0 ～ 80.0세,중위수위51.0세.이미국암증연합위원회(AJCC)표준진행종류분기(2010,제칠판),rT1기27례、rT2기10례,rT3기19례,rT4기15례.소유환자균성공접수내경하복발성비인암절제술,무1례행비외진로수술.평균수술시간위155 min.평균출혈량위450 ml.3례환자술중수혈.무엄중술중、술후병발증,무수술사망병례.술후수방시간위5～96개월.수방기간,48례존활,기중7례대류생존,1례출현폐부전이、1례경부림파결전이.술후2년총체생존솔화무류생존솔분별위74.0％화60.5％.술후5년총체생존솔화무류생존솔분별위39.0％화31.9％.다인소분석표명,종류배사시영향환자생존적독립예후인소(P =0.001).결론 경비내경하수술시복발성비인암안전유효적치료방식지일.
Objective To evaluate the efficacy of endoscopic nasopharyngectomy in the management of recurrent nasopharyngeal cancers (NPC) and to identify the prognostic factors.Methods Between January 2006 and March 2014, 71 patients who received endoscopic nasopharyngectomy for recurrent NPC were retrospectively reviewed.The sex and the age of the patients, T stage, and tumor necrosis were recorded.Correlation between clinicopathological features and survival time was analyzed.Kaplan-Meier analysis was used to calculate the disease overall survival, disease-specific survival, and disease-free survival rates.Cox multivariate regression analysis and ROC curve analysis were used to determine the predictive value of the parameters.Results The median age of 71 patients with recurrent nasopharyngeal carcinoma was 51.0 years old.Male to female ratio was 2.9:1 (male: 53, female: 18).The lesions were staged as follows (AJCC, 2010, seventh edition) : rT1, 27;rT2, 10;rT3, 19 and rT4, 15.All patients underwent successful endoscopic nasopharyngectomy.No patient was transferred to open approach.The mean operative time was 155 minutes.The average blood loss was 450 ml.Three patients needed intraoperative blood transfusion.No serious postoperative complications occurred.Postoperative follow-up time was 5-96 months.During follow-up, 48 cases survived, including that 7 patients survived with disease, 1 patient had pulmonary metastases, and 1 case had cervical lymph node metastasis.Two-year overall survival and disease-free survival rates were 74.0％ and 60.5％, respectively.Five-year overall survival and disease-free survival rates were 39.0％ and 31.9％, respectively.Multivariate analysis showed that tumor necrosis was an independent prognostic factor for survival in recurrent nasopharyngeal carcinoma patients(P =0.001).Conclusion Endoscopic nasopharyngectomy is a safe and effective procedure for the treatment of recurrent nasopharyngeal carcinoma.