【摘要】 背景与目的:鼻咽癌颈部Ⅰb区淋巴结转移发生率低,在精确放疗条件下如何进行照射至今仍是一个有争议的问题,本研究探讨鼻咽癌Ⅰb区淋巴结肿大的发生情况及其对预后的影响。方法:随机抽取1990～1999年间在中山大学肿瘤防治中心病理确诊的初发鼻咽癌病例933例,所有病例均行单纯根治性放疗或加用辅助化疗。根据治疗前CT检查结果判断有无Ⅰb区淋巴结肿大。Ⅰb区淋巴结肿大与治疗后转归如总生存(overall survival,OS),无局部复发生存(locoregional recurrence free survival,LRFS),无远处转移生存(distance metastasis free survival,DMFS)之间的关系采用Kaplan-Meier法评价,并用Cox回归模型进行多因素分析校正其它预后因素的影响。结果:在933例鼻咽癌患者中,共发现Ⅰb区淋巴结肿大55例(5.9%),其发生与颈动脉鞘区侵犯、口咽侵犯、颈区淋巴结累及、颈侧淋巴结累及相关。在颈动脉鞘受侵亚组,用Cox回归模型进行多因素分析校正已知的预后因素,Ⅰb区淋巴结肿大仍是总生存率(RR,2.124;P<0.001)、无远处转移生存率(RR,2.168;P<0.001)和无复发生存率(RR,1.989;P=0.001)下降的危险因素。结论:鼻咽癌患者当颈动脉鞘区受侵犯时,Ⅰb区淋巴结肿大为影响预后的独立因素。更多还原

【Abstract】 Background and Objective:The level-Ⅰb lymph node metastasis is rare in nasopharyngeal carcinoma (NPC).When and how this level should be irradiated in the precision radiotherapy is a controversial problem.This study was to evaluate the incidence and prognostic significance of level-Ⅰb lymphadenopathy in patients with NPC.Methods:From January 1990 to December 1999,933 patients with NPC treated at Sun Yat-sen University Cancer Center were randomly selected,and examined with computed tomography (CT) image for the evidence of level-Ⅰb lymphadenopathy before treatment.All patients received radical radiotherapy with or without chemotherapy.The relationship between level-Ⅰb lymphadenopathy and posttreatment outcomes including overall survival (OS),locoregional recurrencefree survival (LRFS),and distant metastasis-free survival (DMFS) was analyzed using Kaplan-Meier method,and the Cox regression model was used to adjust for other prognostic factors.Results:Of the 933 patients,55 (5.9%) were found to have level-Ⅰb lymphadenopathy,which was associated with carotid sheath involvement,oropharynx involvement,levels and laterals of cervical lymph node involvement.In the subgroup with carotid sheath involvement,multivariate analysis showed that level-Ⅰb lymphadenopathy was still associated with the decrease of OS (RR,2.124;P<0.001),DMFS (RR,2.168;P<0.001),and LRFS (RR,1.989;P=0.001).Conclusion:Level-Ⅰb lymphadenopathy in subgroup with carotid sheath involvement may be an independent prognostic factor for NPC.更多还原