摘要
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155min。平均出血量为450ml。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。
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 nasopharyngeetomy for recurrent NPC were retrospectively reviewed. The sex and the age of the patients, T stage, and tumor necrosis were recorded. Correlation between clinicopathologieal 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.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2015年第11期890-895,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
上海申康医院发展中心新兴前沿项目（SHDC12013121）
关键词
鼻咽肿瘤
内窥镜检查
鼻外科手术
预后
Nasopharyngeal neoplasms
Endoscopy
Nasal surgical procedures
Prognosis
