【摘要】：背景： 鼻咽癌是在我國南方尤其是廣東省最常見的惡性腫瘤之一，發(fā)病率達(dá)到10萬分之30至50，位居世界之首。鼻咽癌95％以上屬于低分化鱗癌，惡性程度高，生長快．易出現(xiàn)遠(yuǎn)處轉(zhuǎn)移,遠(yuǎn)處轉(zhuǎn)移是鼻咽癌致死的最重要的原因，同時也是影響生存的最重要因素。初診為M1期的病人較放療后出現(xiàn)遠(yuǎn)處轉(zhuǎn)移者預(yù)后更差。對于初診時為M1期的病人目前的治療尚無一致意見。關(guān)于初診M1期的鼻咽癌的預(yù)后因素分析的報道也甚少，且這些報道中分析的預(yù)后因素各有不同。 研究目的： 通過關(guān)于初診為M1期的鼻咽病人資料的回顧性分析，找尋并分析對其預(yù)后影響的相關(guān)因素。研究方法： 從2001年1月至2007年12月，92例資料完整的初治時確診為遠(yuǎn)處轉(zhuǎn)移的鼻咽癌病人在廣州醫(yī)學(xué)院附屬腫瘤醫(yī)院住院治療，其中75例男性，17例女性，中位年齡為47歲（14-71歲），骨轉(zhuǎn)移最常見，單純骨轉(zhuǎn)移39例，單純肺轉(zhuǎn)移13例，單純肝轉(zhuǎn)移11例，其他器官2例，多器官轉(zhuǎn)移27例，68例病人接受了原發(fā)鼻咽病灶放療及全身化療，24例僅接受全身化療。接受原發(fā)灶放療的病人中，，總的鼻咽病灶外照射劑量為50-72Gy(中位劑量66Gy)，頸部劑量50～66Gy(中位劑量56Gy)。全組病人接受化療共371程，主要以順鉑為基礎(chǔ)的方案進(jìn)行，化療1～12個周期，其中化療4個療程46例，化療≥4個療程46例，采用用Kaplan-Meier法計算生存率，log-rank檢驗各組生存率，并用Cox逐步回歸模型進(jìn)行多因素分析,分析的因素包括：性別、年齡（大于等于或小于45歲）、N分期、T分期、是否多臟器轉(zhuǎn)移、單純肝、骨、肺轉(zhuǎn)移、是否原發(fā)灶放療、化療程數(shù)（大于等于4程或者小于4程）。 研究結(jié)果： 全組患者1、2、3生存率分別為68.4％、35.8％、15.2％,中位生存期為17(1～65)個月。單因素分析結(jié)果提示N分期（P=0.004），多臟器轉(zhuǎn)移（P=0.000）、原發(fā)灶放療（P=0.000)、化療程數(shù)(P=0.022)是初診轉(zhuǎn)移性鼻咽癌預(yù)后的影響因素。多因素分析結(jié)果提示N分期（P=0.006）、多器官轉(zhuǎn)移（P=0.005）、化療程數(shù)(P=0.015)和原發(fā)灶放療（P=0.018）是影響初診時已有轉(zhuǎn)移性鼻咽癌預(yù)后的獨立因素。 結(jié)論： 通過對初診為M1期的鼻咽癌的患者資料行單因素及多因素分析，結(jié)果提示N分期、多臟器轉(zhuǎn)移、原發(fā)灶放療及化療程數(shù)是獨立預(yù)后因素。從上述資料看，對于初診為M1期的鼻咽癌病人，予以原發(fā)灶放療聯(lián)合大于4程的化療可改善生存，這樣的結(jié)果還待大宗的隨機(jī)對照臨床實驗來加以驗證。
[Abstract]:Background: nasopharyngeal carcinoma (NPC) is one of the most common malignant tumors in southern China, especially in Guangdong Province. More than 95% of nasopharyngeal carcinoma belongs to poorly differentiated squamous cell carcinoma with high malignancy and rapid growth. Distant metastasis is the most important cause of death and the most important factor affecting the survival of nasopharyngeal carcinoma. The prognosis of M 1 patients was worse than that of patients with distant metastasis after radiotherapy. There is no consensus on current treatment for first-diagnosed M 1 patients. There are few reports on prognostic factors analysis of nasopharyngeal carcinoma (NPC) in newly diagnosed M1 stage, and the prognostic factors are different in these reports. Objective: to study the prognostic factors of nasopharyngeal patients in M1 stage by retrospective analysis. Methods: from January 2001 to December 2007, 92 patients with nasopharyngeal carcinoma diagnosed as distant metastasis were admitted to the affiliated Cancer Hospital of Guangzhou Medical College, including 75 males and 17 females. The median age was 47 years (14-71 years). Bone metastasis was most common in 39 cases of simple bone metastasis, 13 cases of simple lung metastasis, 11 cases of simple liver metastasis, and 2 cases of other organs. Twenty-seven patients with multiple organ metastasis received primary nasopharyngeal focus radiotherapy and systemic chemotherapy. 24 patients received systemic chemotherapy only. The total external dose of nasopharyngeal focus was 50-72Gy (median dose 66Gy) and cervical dose of 50~66Gy (median dose 56Gy). A total of 371 courses of chemotherapy were performed in the whole group. The chemotherapy was based on cisplatin regimen. There were 46 patients with 4 courses of chemotherapy and 46 patients with chemotherapy 鈮

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