本文選題：鼻咽癌 + 遠(yuǎn)處轉(zhuǎn)移��； 參考：《福建醫(yī)科大學(xué)》2011年碩士論文

【摘要】：目的分析鼻咽癌根治性放療后發(fā)生遠(yuǎn)處轉(zhuǎn)移患者的生存預(yù)后因素,同時(shí)進(jìn)一步探討轉(zhuǎn)移性鼻咽癌治療后長(zhǎng)期生存患者的特征及生存相關(guān)因素,為此類型患者的規(guī)范治療及個(gè)體化治療方案的制定提供依據(jù)。 方法回顧性分析根治性放療后發(fā)生遠(yuǎn)處轉(zhuǎn)移的鼻咽癌184例,Kaplan—Meier法計(jì)算生存率;Log—rank test對(duì)生存率差異進(jìn)行顯著性檢驗(yàn)。采用Cox風(fēng)險(xiǎn)比模型進(jìn)行單因素及多因素分析。對(duì)其中長(zhǎng)期生存者,分析歸納其特征。 結(jié)果全組中位生存12個(gè)月,1、2、3年生存率分別為50.6%、30.7%和20.9%,單因素分析發(fā)現(xiàn),放療后發(fā)生轉(zhuǎn)移患者的生存時(shí)間與初診時(shí)N分期、初診時(shí)是否化療、首程放療結(jié)束發(fā)生遠(yuǎn)處轉(zhuǎn)移的時(shí)間間隔、轉(zhuǎn)移部位、轉(zhuǎn)移后是否化療及化療的周期數(shù)、轉(zhuǎn)移后是否行姑息放療有關(guān)。Cox回歸分析顯示初診時(shí)N分期、轉(zhuǎn)移部位、轉(zhuǎn)移后是否化療、是否姑息放療、初治放療結(jié)束到遠(yuǎn)處轉(zhuǎn)移的時(shí)間間隔對(duì)于轉(zhuǎn)移性鼻咽癌患者的生存具有獨(dú)立的預(yù)后意義。其中轉(zhuǎn)移性鼻咽癌治療后長(zhǎng)期生存患者的特征為:①放療結(jié)束到發(fā)生轉(zhuǎn)移的中位時(shí)間≥22月。②轉(zhuǎn)移部位多為單臟器、單病灶,轉(zhuǎn)移灶較小或者多發(fā)骨轉(zhuǎn)移病灶分布相對(duì)集中。③轉(zhuǎn)移后接受了全身化療且化療周期≥4周期。④轉(zhuǎn)移灶(單發(fā)或多發(fā))接受了姑息放療為主的局部治療。 結(jié)論:(1)鼻咽癌放療后遠(yuǎn)處轉(zhuǎn)移患者的預(yù)后與初治放療結(jié)束到遠(yuǎn)處轉(zhuǎn)移的時(shí)間間隔、轉(zhuǎn)移灶部位、轉(zhuǎn)移灶數(shù)目及治療方式有關(guān);(2)全身化療和局部姑息放療是轉(zhuǎn)移性鼻咽癌患者的主要治療方式。
[Abstract]:Objective to analyze the prognostic factors of patients with distant metastasis after radical radiotherapy of nasopharyngeal carcinoma (NPC), and to explore the characteristics and survival related factors of patients with metastatic nasopharyngeal carcinoma (NPC) after radiotherapy. Therefore, the standard treatment and individualized treatment of the type of patients to provide the basis for the formulation. Methods the survival rate of 184 cases of nasopharyngeal carcinoma with distant metastasis after radical radiotherapy was analyzed retrospectively. The survival rate was calculated by Kaplan-Meier method and Log-rank test was used to test the difference of survival rate. Cox risk ratio model was used to analyze single factor and multi-factor. The characteristics of the long-term survivors are analyzed and summarized. Results the median survival rate for 12 months and 3 years were 50.6% and 20.9%, respectively. Univariate analysis showed that the survival time of the patients with metastasis after radiotherapy was related to the N stage at the first visit and whether the patients were treated with chemotherapy or not. The interval of distant metastasis at the end of first stage radiotherapy, the location of metastasis, the number of cycles of chemotherapy and chemotherapy after metastasis, and whether palliative radiotherapy was performed after metastasis. Cox regression analysis showed that N stage, location of metastasis, and chemotherapy after metastasis. Whether palliative radiotherapy, the time interval between the end of primary radiotherapy and distant metastasis has an independent prognostic significance for the survival of metastatic nasopharyngeal carcinoma. The characteristics of long term survival after treatment of metastatic nasopharyngeal carcinoma were that the median time from the end of 1 radiotherapy to metastasis was more than 22 months, and most of the metastatic sites were single organ and single focus. Patients with small or multiple bone metastases received systemic chemotherapy and chemotherapy cycles 鈮，

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