【作者】 潘建基； 宗井凤； 林少俊； 张瑜； 陈韵彬； 郭巧娟；

【Author】 J.Pan~1,J.Zong~1,S.Lin~1,Y.Zhang~1,Y.Chen~2,Q.Guo~1 Department of Radiation Oncology,Cancer Hospital of Fujian Medical University,Fuzhou,China, Department of Diagnostic Radiology,Cancer Hospital of Fujian Medical University,Fuzhou,China

【机构】 福建医科大学教学医院,福建省肿瘤医院放疗科； 福建医科大学教学医院,福建省肿瘤医院放诊科；

【摘要】 目的:AJCC第七版对鼻咽癌分期标准进行了修订,中国92分期也已经被修订1年了,新的分期称为鼻咽癌2008分期,本研究探讨两种新的分期标准的预后作用。材料与方法:回顾分析799例行鼻咽和颈部MRI扫描的无远处转移鼻咽癌初诊患者的临床及影像资料,收集其临床及影像学资料,分别根据鼻咽癌2008分期与AJCC分期标准重新分期,比较两种分期系统的病例分布、生存及预后情况。结果:中位随访36个月（2-54个月）,3年总生存率率为84.9%。两种分期中T分期、N分期和临床分期的病例分布相似,临床分期符合率81.2%.仅71例（8.9%）的病人为N0,导致Ⅰ期病例数仅占1.8%.T分期局部复发生存曲线和临床分期疾病相关生存曲线也比较一致。T1,T2和T3间的无局部复发生存率差异无统计学意义。2008分期标准下N₀与N_1a期曲线相交叉,但N_1b与N₂、N₂与N₃期曲线均能较好拉开。而根据AJCC分期,N₁与N₂、N₂与N₃期生存率差别均无统计学意义。结论:两种分期标准的预后作用相似,T1-T3的局部复发率差别无统计学意义。当咽后淋巴结归为N1,N0与Ⅰ期病例数比例非常少。我们认为,咽后淋巴结的预后意义值得进一步探讨。更多还原

【Abstract】 Purpose: The seventh edition of the American Joint Committee on Cancer(AJCC) staging manual defines new rules for classifying nasopharyngeal carcinoma(NPC).The Chinese 1992 staging system had also been revised one year ago.the new name was the Chinese 2008 staging system.The current study compares the two in predicting NPC prognosis. Methods and Materials:A total of 799 patients presented with untreated nondisseminated NPC who had received magnetic resonance imaging(MRI) scan of the nasopharynx and neck were studied retrospectively.The clinical materials and information of imaging were collected.All patients were restaged according to the AJCC staging system and Chinese 2008 staging system of nasopharyngeal carcinoma. Distribution of patients,survival and prognostic value were compared. Results:The median follow-up for the whole group was 36 months(range 2 54).The 3-year overall survival rates were 84.9%.By two staging systems,patient distributions in T,N and clinical stage were similar;the agreement rate for clinical stage was 81.2%.Only 71(8.9%) patients had NO disease,which caused the percentage of patients with stage I was only 1.8%.Survival curves for free from local failure survival and disease specific survival were also similar.The difference for local failure survival between T1, T2 and T3 was of no statistical significance.For the Chinese 2008 staging system,the distant failure-free survival curves for NO and N1a were overlap,and survival curves showed better separation between N1b, N2,and N3.However,for the AJCC staging system,no statistical significance was found in the rate of distant metastasis between NO and N1,and between N2 and N3. Conclusions:Both systems have the similar prognostic value.There are no statistical differences for local relapse rate between T1,T2 and T3.When retropharyngeal lymph node(RLN) was defined as N1 disease,the percentages of patients with stage NO and stageⅠwere small.In the opinion of the authors,the prognostic value of RLN needs more investigation.更多还原