鼻咽癌咽旁间隙受侵对远处转移影响的研究

目的：分析鼻咽癌咽旁间隙受侵对患者治疗后远处转移的影响。方法：1999年全年住院治疗的原发鼻咽癌患者405例，对其中接受放射治疗并完成根治剂量、治疗前及治疗中无远处转移证据且随访资料完整者381例进行回顾性分析。结果：咽旁间隙侵犯与未侵犯者5年累积无远处转移生存率分别为73．57％和86．19％，P=0．0042；茎突前间隙侵犯与未侵犯者分别为73．03％和86．80％，P=0．0017；茎突后间隙侵犯与未侵犯者分别为66．63％和86．23％，P=0．0000。无远处转移生存率相关因素为颈淋巴结转移、茎突后间隙受侵和临床分期。结论：咽旁间隙受侵尤其是茎突后间隙受侵与远处转移密切相关，茎突后间隙受侵时转移淋巴结的分期与远处转移无关。     

鼻咽癌咽旁间隙侵犯对预后的影响

目的:探讨鼻咽癌咽旁间隙受侵对预后的影响。方法:咽旁间隙的侵犯程度根据SO线(茎突到枕骨大孔中线后缘中点连线)进行划分,无咽旁侵犯记录为0级,SO线以前的咽旁侵犯记录为1级,SO线以后记录为2级。KaplanMeier法计算总生存率、无瘤生存率、无局部复发生存率和无远处转移生存率,Cox模型进行预后的多因素分析。结果:176例患者中,咽旁受侵的发生率为81.8%,其中1级为70.1%,2级为29.9%。咽旁间隙受侵与颈部淋巴结转移有明显相关性,χ2=8.185,P=0.0040。咽旁受侵0、1和2级患者5年总生存率分别为90.2%、75.1%和51.2%,logrank检验值为16.45,P=0.0003;5年无瘤生存率分别为87.2%、71.5%和53.3%,logrank检验值为10.87,P=0.0044;5年无远处转移生存率分别是93.7%、82.2%和62.7%,logrank检验值为9.41,P=0.0091。多因素分析显示,咽旁受侵不是独立的预后因素,但严重咽旁间隙侵犯是影响鼻咽癌总生存、无瘤生存及远处转移的独立预后因素。结论:咽旁侵犯应该根据程度进行划分,单纯咽旁侵犯的有无不能独立的影响预后,但根据咽旁侵犯程度进行分级后,严重的咽旁侵犯是影响总生存、无瘤生存和远处转移的独立预后因素。     

基于磁共振鼻咽癌咽旁间隙侵犯与预后关系的探讨

[目的]探讨基于磁共振鼻咽癌咽旁间隙受侵对预后的影响。[方法]185例M0期鼻咽癌患者,按咽旁间隙的侵犯程度进行划分,无咽旁侵犯记为0级,有咽旁侵犯而无颈动脉鞘区侵犯记为1级,有颈动脉鞘区侵犯记为2级。Kaplan-Meier法计算生存率,Cox模型进行预后多因素分析。[结果]咽旁间隙受侵与颅底骨质破坏有明显相关性（r=0.15,P=0.041）。多因素分析显示咽旁受侵不是独立的预后因素,但颈动脉鞘区受侵是影响鼻咽癌总生存、无远处转移的独立预后因素。[结论]单纯的咽旁受侵不影响预后,颈动脉鞘区受侵是独立预后因素。     

鼻咽癌咽旁间隙受侵不同照射野放射治疗的疗效分析

目的 :评价鼻咽癌咽旁间隙受侵不同照射野放射治疗的疗效。方法 :收集 1993年 1月— 1995年 12月经病理确诊、CT扫描证实有咽旁侵犯的鼻咽癌 34 8例 ,按放射治疗设野不同分为面颈联合野组和耳前野组 ,对 5年生存率、局控率、无远处转移生存率和急慢性放射损伤进行分析和评价。结果 :面颈联合野组 5年生存率高于耳前野组 (P<0 .0 5 ) ,面颈联合野组 5年局控率明显高于耳前野组 (P<0 .0 1) ,咽旁后间隙受侵面颈联合野组 5年生存率高于耳前野组 (P<0 .0 5 ) ,咽旁前间隙受侵 5年生存率两组比较无明显差异 (P>0 .0 5 ) ,面颈联合野组发生放射性咽炎、口干反应明显高于耳前野组 (P<0 .0 1) ,放射性脊髓炎、放射性脑病两组比较差异无显著性 (P>0 .0 5 )。结论 :鼻咽癌咽旁后间隙受侵应选用面颈联合野放射治疗     

鼻咽癌咽旁间隙受侵对预后的影响

目的 探讨鼻咽癌咽旁间隙受侵对患者预后的影响。方法 1987年1月994年12月间对197例初程治疗的鼻咽半成品 患者进行CT扫描检查，利用SPSS8.0软件进行单因素和多因素分析影响预后的因素。结果 咽旁间隙受侵对实际生存、无瘤生存及局部控制有影响（P=0.0115,P=0.003,P=0.0367)。咽旁间隙阴性患者的5年实际生存率、无瘤生存率和局部控制率分别为87.9%,88.0%和96.9%，茎突前暗隙受侵分别为75.0%、71.2%和93.7%，茎突后间隙受侵分别为60.5%、57.7%和86.8%。结论 咽旁间隙受侵影响生存及局部控制，当茎突后间隙明显受侵时，远处转移的机会增加。     

鼻咽癌咽旁侵犯程度划分方法对预后的影响

目的:探讨咽旁侵犯对鼻咽癌预后的影响,并对多种咽旁侵犯程度的划分方法进行比较,以寻求能较好反映预后的划分。方法:2000-01-2000-07经病理确诊的初治M0期鼻咽癌患者176例纳入研究。根据4种咽旁划分方法(闵氏、Sham氏、肖氏和Heng氏建议的划分)对咽旁间隙的侵犯程度划分,前瞻性研究其对鼻咽癌预后的影响。结果:鼻咽癌咽旁侵犯的发生率为81.8%(144/176)。有咽旁侵犯和无咽旁侵犯的5年总生存率分别是68.1%和90.2%(P=0.010),5年无瘤生存率分别是66.1%和87.2%(P=0.013),5年无远处转移生存率分别是76.7%和93.6%(P=0.032),5年无局部复发生存率分别是84.9%和93.1%,P=0.220。Cox模型多因素分析显示,咽旁是否侵犯并不是独立预后因素,然而根据程度分级后的咽旁侵犯是影响预后的独立因素。4种咽旁划分同时纳入Cox多因素分析显示,闵氏划分的咽旁侵犯是影响总生存的独立预后因素(HR:2.231;P=0.001),Sham氏划分的咽旁侵犯是影响无瘤生存(HR:1.487;P=0.010)和远处转移(HR:1.246;P=0.009)的独立预后因素...     

鼻咽癌咽旁侵犯患者的远期疗效分析

目的 通过对鼻咽癌咽旁侵犯患者的远期疗效的分析，为合理的设野和临床分期提供依据。方法 对1984年10月至1989年9月收治的经病理、CT检查诊断有咽旁侵犯的120例鼻咽癌患者，采用常规分段放射治疗。鼻咽原发灶设两耳前野为主，部分辅以鼻前野。鼻咽肿瘤总剂量为68～78Gy，照射34～39次／72～85天。颈部根治性肿瘤总剂量为60～68Gy，照射30～34次／72～76天；预防剂量为50Gy。全部病例5年随访率为100．0％，10年随访率为95．0％。结果 茎突前区和茎突后区受侵犯者5年生存率分别为66．1％和44.8％，10年生存率分别为37．1％和25．9％；颈部淋巴结Ⅱ、Ⅲ期10年生存率分别为35．6％和28．0％；2年内鼻咽复发率分别为19．4％和44．8％。茎突前区咽旁侵犯同时伴有颅底骨质破坏、颅神经损害和口咽侵犯的发生率分别为6．5％、6．5％和11．3％，而茎突后区分别为19．0％、25．9％和36．2％。结论 咽旁侵犯是影响鼻咽癌预后的重要因素，然而，不排除因当时技术条件受限对预后的影响。     

38例鼻咽癌腔外侵犯的CT扫描分析

（目的）分析鼻咽癌腔外侵犯的情况及其与颈部淋巴结转移的关系。（方法）总结38例经活检病理证实为鼻咽癌患者的CT图像。平扫11例，平扫加增强27例，横断加冠状位扫描4例。层厚、层距各5mm。（结果）38例均有鼻咽腔变形、局部隆起、粘膜下增厚肿块、咽隐窝挤压、消失等变化。参照黎福祥的咽旁间隙划区方法，94．7％有不同程度咽旁间隙侵犯。咽旁间隙后区受侵者，颈淋巴结转移63．3％（19／30）。口咽受侵者，颈淋巴结转移率为100％（10／10）。受侵部位大于3个者，颈淋巴结转移率为86．6％（13／15）。（结论）CT扫描对鼻咽癌诊断及明确侵及部位具有重要价值。合理扫描可增加肿瘤侵及范围的检出率。咽旁后间隙受侵、口咽受侵及部位多者其颈淋巴结转移率高，这对放疗设野具有重要参考价值。     

鼻咽癌咽旁间隙侵犯对预后的影响

目的：探讨鼻咽癌咽旁间隙侵犯程度与预后的关系。方法：２１９例初诊鼻咽癌经ＣＴ扫描将咽旁间隙侵犯程度分为：０级：无侵犯；Ⅰ级：轻度侵犯；Ⅱ级：重度侵犯。应用Ｋａｐｌａｎ－Ｍｅｉｅｒ方法和Ｃｏｘ模型对施疗后５年的局控率、无远外转移生存率、无瘤生存率及影响预后因素进行分析和评价。结果：咽旁０、Ⅰ、Ⅱ级侵犯的５年无瘤生存率分别为６９．９１％、６０．７２％、３２．１３％，后者明显低于前两者（Ｐ≤０．０００３     

鼻咽癌茎突后间隙侵犯的临床意义探讨

目的探讨鼻咽癌茎突后间隙侵犯的临床意义。方法１９８例Ｉ～Ⅳａ期鼻咽癌住院初治患者接受根治放疗。按茎突后间隙有无侵犯分为茎后侵犯组和茎后无侵犯组。应用Ｋａｐｌａｎ－Ｍｅｉｅｒ，Ｌｏｇ－Ｒａｎｋ及卡方检验等方法对两组病人５ａ生存率、局控率和无远处转移生存率进行分析和评价。结果两组５ａ生存率分别为４６．７６％和６８．８８％（Ｐ＝０．００２７），两组无远处转移生存率分别为７１．６８％和８４．２２％（Ｐ＝０．０４６８）。结果表明茎突后间隙侵犯者生存率和局控率降低，远处转移增多。结论茎突后间隙的侵犯是影响预后的重要因素之一，在分期上将之划归Ｔ３是合理的；在鼻咽癌放射治疗设计中，鼻咽、咽旁特别是茎突后间隙、颅底、上颈淋巴结引流区应设置在同一靶区内。     

Prognostic factors and failure patterns in non-metastatic nasopharyngeal carcinoma after intensity-modulated radiotherapy

Background:The prognostic values of staging parameters require continual re?assessment amid changes in diag?nostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of non?meta?static nasopharyngeal carcinoma (NPC) in the intensity?modulated radiotherapy (IMRT) era. Methods:We reviewed the data from 749 patients with newly diagnosed, biopsy?proven, non?metastatic NPC in our cancer center (South China, an NPC endemic area) between January 2003 and December 2007. All patients under?went magnetic resonance imaging (MRI) before receiving IMRT. The actuarial survival rates were estimated using the Kaplan–Meier method, and survival curves were compared using the log?rank test. Multivariate analyses with the Cox proportional hazards model were used to test for the independent prognostic factors by backward eliminating insigniifcant explanatory variables. Results:The 5?year occurrence rates of local failure, regional failure, locoregional failure, and distant failure were 5.4, 3.0, 7.4, and 17.4%, respectively. The 5?year survival rates were as follows: local relapse?free survival, 94.6%; nodal relapse?free survival, 97.0%; distant metastasis?free survival, 82.6%; disease?free survival, 75.1%; and overall survival, 82.0%. Multivariate Cox regression analysis revealed that orbit involvement was the only signiifcant prognostic fac?tor for local failure (P=0.011). Parapharyngeal tumor extension, retropharyngeal lymph node involvement, and the laterality, longest diameter, and Ho’s location of the cervical lymph nodes were signiifcant prognostic factors for both distant failure and disease failure (allP<0.05). Intracranial extension had signiifcant prognostic value for distant failure (P=0.040). Conclusions:The key failure pattern for NPC was distant metastasis in the IMRT era. With changes in diagnostic and therapeutic technologies as well as treatment modalities, the signiifcant prognostic parameters for local control have also been altered substantially.     

N2~3期局部晚期鼻咽癌不同新辅助化疗疗程预后分析

 目的 探讨不同新辅助化疗（NCT）疗程对N2~3期局部晚期鼻咽癌的预后影响。方法 回顾性分析2012—2013年收治的270例N2~3期局部晚期鼻咽癌行新辅助化疗+同步放化疗或单纯同步放化疗患者的一般临床资料,全组NCT≥3程、NCT=1~2程、NCT=0程患者分别为84例、106例和80例。Kaplan-Meier法计算生存率并行Log rank法检验,Cox单、多因素分析无远处转移生存影响因素。 结果 全组中位随访时间63月（6~75月）。全组5年总生存（5-OS）、无瘤生存（5-DFS）、无局部复发生存（5-LRFS）和无远处转移生存率（5-DMFS）分别为78.4%、77.8%、97.7%和79.5%。三组5-OS分别为88.1%、78.8%和73.5%（P=0.03）;三组5-DFS分别为89.3%、74.0%和72.3%（P=0.021）,三组5-DMFS分别为89.3%、76.6%和74.5%（P=0.031）,三组5-LRFS差异无统计学意义（P=0.535）;单、多因素分析提示新辅助化疗疗程、N分期、年龄均是治疗后有无转移的独立预后因素。结论 N2~3期局部晚期鼻咽癌患者行NCT≥3程诱导化疗+同步放化疗可明显提高总生存期、降低远处转移率。     

非转移性T4期鼻咽癌的预后影响因素分析

目的探讨非转移性ⅣA期鼻咽癌的预后影响因子。方法初治的T4N0~3M0 (UICC 1997版分期)鼻咽癌患者145例纳入临床研究,分析患者的复发、转移、生存情况及预后影响因素。结果145例患者的5年OS、CCS、PFS、DLRFS、DMFS分别为59.2％、61.3％、53.0％、71.6％、62.6％。多因素分析显示：颈动脉鞘区受侵是影响DLRFS、DMFS的不良预后因素,UICC N分期是影响DLRFS、 DMFS的独立预后因素;颈动脉鞘区受侵是影响CCS的独立不良预后因素,年龄、颈部照射剂量、UICC N分期是影响CCS的独立预后因素。单因素分析显示: 颈动脉鞘区受侵、UICC N分期是影响CCS、PFS的预后因素,同期化疗或放疗联合化疗虽提示有提高DMFS及提高CCS的趋势,但差异无统计学意义（P＞0.05）。结论颈动脉鞘区受侵、UICC N分期是影响非转移性T4期鼻咽癌的重要预后因子。     

Prognostic influence of parapharyngeal space involvement in nasopharyngeal carcinoma

PURPOSE: To assess the prognostic influence of parapharyngeal space involvement in nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: From January 1987 to December 1994, 197 untreated NPC patients were examined by CT scan before treatment. The parapharyngeal space was separated into pre-styloid and post-styloid compartments on axial images by the styloid process. Potentially significant parameters were analyzed by both univariate and multivariate methods using SPSS 8.0 software. RESULTS: The actual survival, disease-free survival, and local failure-free rates were affected by the presence of parapharyngeal space involvement (p = 0.0115, p = 0.0035, p = 0.0367, respectively). The 5-year actual survival, disease-free survival, and the local failure-free rates in the patients without parapharyngeal space disease, or with pre-styloid and post-styloid compartment involvement were 87.9%, 88.0%, 96.9% and 75.0%, 71.2%, 93.7% and 60.5%, 57.7%, 86.8%, respectively. Parapharyngeal space involvement correlated well with lymphadenopathy and advanced N disease. Distant metastasis is more likely in the presence of obvious post-styloid compartment involvement (p = 0.0153). Age is a strong prognostic factor for survival.CONCLUSION: Parapharyngeal tumor involvement has significant predictive value. The parapharyngeal space involvement affects local tumor failure, regional tumor failure, and distant metastasis. Its survival rate is low     

72例转移性鼻咽癌的预后分析

目的 探讨转移性鼻咽癌预后的相关因素.方法 分析2004年9月至2008年9月我科确诊的72例转移性鼻咽癌患者的预后因素,其中男性62例,女性10例,中位年龄50岁(28-81岁).比较单发转移组(14例)与多发转移组(58例)、转移合并局部复发组(14例)和转移无局部复发组(58例)以及综合治疗组(61例)和单纯支持治疗组(11例)间的生存率.Kaplan-Meier法计算生存率,log-rank检验各组生存率,Cox逐步回归模型进行多因素分析.结果 转移合并局部复发组1年、2年生存率14.3%、1.1%,中位生存期8.2个月,较转移无局部复发组生存率及中位生存期(38.5%、20.3%、11.6m)低,P<0.05.单发转移组与多发转移组1年、2年生存率分别为47.5%、20.0%与37.5%、12.5%,P>0.05.综合治疗组与支持治疗组1年、2年生存率分别为47.2%、16.1%与40.0%、12.0%,P>0.05.两组间生存率无统计学差异.多因素分析显示性别(P=0.026)、合并局部复发(P=0.020)是影响转移性鼻咽癌预后的独立因素.结论 转移性鼻咽癌以化疗为主的综合治疗并未提高总生存率.性别、有合并局部复发是影响转移性鼻咽癌预后的独立影响因素.     

72例转移性鼻咽癌的预后分析

目的：探讨转移性鼻咽癌预后的相关因素。方法：分析2004年9月至2008年9月我科确诊的72例转移性鼻咽癌患者的预后因素,其中男性62例,女性10例,中位年龄50岁（28-81岁）。比较单发转移组（14例）与多发转移组（58例）、转移合并局部复发组（14例）和转移无局部复发组（58例）以及综合治疗组（61例）和单纯支持治疗组（11例）间的生存率。Kaplan-Meier法计算生存率,log-rank检验各组生存率,Cox逐步回归模型进行多因素分析。结果：转移合并局部复发组1年、2年生存率14.3%、1.1%,中位生存期8.2个月,较转移无局部复发组生存率及中位生存期（38.5%、20.3%、11.6m）低,P〈0.05。单发转移组与多发转移组1年、2年生存率分别为47.5%、20.0%与37.5%、12.5%,P〉0.05。综合治疗组与支持治疗组1年、2年生存率分别为47.2%、16.1%与40.0%、12.0%,P〉0.05。两组间生存率无统计学差异。多因素分析显示性别（P=0.026）、合并局部复发（P=0.020）是影响转移性鼻咽癌预后的独立因素。结论：转移性鼻咽癌以化疗为主的综合治疗并未提高总生存率。性别、有合并局部复发是影响转移性鼻咽癌预后的独立影响因素。     

Tumor size predicts the survival of patients with pathologic stage T2 bladder carcinoma: a critical evaluation of the depth of muscle invasion.

BACKGROUND: Accurate examination of radical cystectomy specimens is critical for stratifying patients into prognostically important groups and determining the need for adjuvant treatment. Evidence has accumulated that cancers invading the superficial muscle wall (T2a) behave similarly to those invading the deep muscle wall (T2b). Quantitative analysis of the depth of invasion in relation to patient outcome is needed. METHODS: The authors systematically evaluated the depth of invasion by micrometer measurement and its relation to the survival of 64 patients with bladder carcinoma pathologic classification as pT2 who had long term follow-up after radical cystectomy. Numerous clinical and pathologic variables were analyzed with univariate and multivariate Cox proportional hazards models. The mean age of patients was 64 years, and their mean follow-up was 8.3 years. RESULTS: There was no significant difference in clinical outcome between patients with T2a carcinoma and those with T2b. Lymph node metastasis and tumor size were each significantly associated with distant metastasis free and cancer specific survival. Ten-year distant metastasis free and cancer specific survival were 100% and 94%, respectively, for patients with tumors <3 cm (P = 0.006) and 68% and 73%, respectively, for patients with tumors > or = 3 cm (P = 0.005). After adjustment for lymph node status, tumor size maintained significance in predicting distant metastasis free survival (risk ratio, 1.5; 95% confidence interval, 1.1-2.0; P = 0.009) and cancer specific survival (risk ratio, 1.5; 95% confidence interval, 1.1-1.9; P = 0.01). Age was associated with recurrence free survival and all-cause survival. None of the other variables, including gender, vascular invasion, presence of carcinoma in situ, pathologic classification (T2a vs. T2b), depth of invasion, depth of muscle invasion, ratio of depth of invasion to bladder wall thickness, and percentage of muscle wall invasion, were significantly associated with patient outcome. CONCLUSIONS: The findings of this study indicate that the subclassification of T2 bladder carcinoma by depth of muscle invasion is of no prognostic value; conversely, tumor size, an easily measured factor, is predictive of distant metastasis free and cancer specific survival.     

Prognostic value of magnetic resonance imaging-detected cranial nerve invasion in nasopharyngeal carcinoma

Background:

We previously reported that magnetic resonance imaging evidence of cranial nerve invasion was an unfavourable prognostic factor in nasopharyngeal carcinoma. However, the prognostic value of this evidence in nasopharyngeal carcinoma treated with intensity-modulated radiotherapy remains unknown.

Methods:

We retrospectively analysed 749 nasopharyngeal carcinoma patients who underwent intensity-modulated radiotherapy.

Results:

Cranial nerve invasion was observed in 299 (39.9%) patients with T3–4 disease. In T3–4 nasopharyngeal carcinoma, magnetic resonance imaging-detected cranial nerve invasion was associated with inferior 5-year overall survival, distant metastasis-free survival, and locoregional relapse-free survival (P=0.002, 0.003, and 0.012, respectively). Multivariate analyses confirmed that cranial nerve invasion was an independent prognostic factor for distant metastasis-free survival (hazard ratio, 1.927; P=0.019) and locoregional relapse-free survival (hazard ratio, 2.605; P=0.032). Furthermore, the receiver-operating characteristic curves verified that the predictive validity of T classifications was significantly improved when combined with magnetic resonance imaging-detected cranial nerve invasion in terms of death, distant metastasis, and locoregional recurrence (P=0.015, 0.021 and 0.008, respectively).

Conclusions:

Magnetic resonance imaging-detected cranial nerve invasion is an independent adverse prognostic factor in nasopharyngeal carcinoma treated with intensity-modulated radiotherapy.