94例鼻腔恶性肿瘤的治疗和预后分析

  目的  评价94例鼻腔恶性肿瘤的治疗效果, 比较各期治疗方案, 并探讨影响鼻腔癌患者预后的因素。   方法  生存分析采用Kaplan-Meier法, 组间比较采用Log-rank检验。多因素分析采用Cox模型。   结果  全组患者的5年总生存率为58.2%, 其中青少年组高于中老年组(P < 0.05);早期患者高于晚期患者(P < 0.01);颈部淋巴结阳性者低于阴性者(P < 0.05)。94例患者接受的治疗方法分为4种, 放疗+/-化疗组、手术+/-化疗组、放疗+手术+/-化疗组、单纯化疗组。4种治疗方法的5年总生存率比较差异有统计学意义(P < 0.05)。多因素分析显示, 临床分期是影响预后的独立因素。   结论  对于早期患者, 放疗、手术、放疗+手术三种治疗方法无统计学差异。对于晚期患者, 单纯化疗预后最差, 推荐综合治疗。临床分期是影响预后的独立因素。 

Treatment and Prognosis of 94 Cases of Malignant Tumor in the Nasal Cavity

  Objective  Malignant tumor in the nasal cavity is a disease with a low incidence rate that is rarely reported.Presently, no consensus has been reached on its standard treatment and prognostic factors.This study aims to investigate effective treatment and prognostic factors through the evaluation of treatment outcomes.   Methods  The records of 94 NPC patients were reviewed.Among the 94 cases, 22 received radiotherapy +/- chemotherapy, 30 underwent surgery +/- chemotherapy, 31 received radiotherapy plus surgery +/- chemotherapy, and 11 received chemotherapy only.Survival analysis was conducted using the Kaplan-Meier method, in which the differences between the groups were detected using the logrank test.Multivariate analysis was performed using the Cox proportional hazards model.   Results  The overall 5-year survival rate was 58.2%.Patients below 40 years old had lower survival rate compared with those over 40 years old(P < 0.05).The 5-year survival rate in the patients with stageⅠtumor and stageⅡtumor was 84.6%, and that in the patients with stageⅢtumor and stageⅣtumor was 37.8%(P < 0.01).The patients who were initially diagnosed with cervical lymph node exhibited reduced survival rate compared with the node-negative patients.The overall 5-year survival rate of the patients treated with radiotherapy +/- chemotherapy was 51.1%, and that of the patients treated with surgery +/- chemotherapy reached 65.1%. The survival rate of the patients who underwent radiotherapy plus surgery +/- chemotherapy was 70.5%, whereas that of the patients who received simple chemotherapy was merely 18.2%(P < 0.05).Using Cox regression, clinical stage was determined as the independent prognostic factor.   Conclusion  For early-stage NPC patients, no difference was found among simple surgery, radiotherapy only, and surgery combined with radiation therapy.Comprehensive treatment is preferred for patients with advanced-stage NPC, whereas simple chemotherapy may be the worst choice.Clinical staging is an independent prognostic factor for NPC patients.