Farias Terence P, Dias Fernando L, Lima Roberto A, Kligerman Jacob, de Sá Geraldo M, Barbosa Mauro M, Gonçalves Fernando B
Department of Head and Neck Surgery, Hospital do Câncer I, Instituto Nacional de Cancer, Rio de Janeiro, Brazil.
Arch Otolaryngol Head Neck Surg. 2003 Jul;129(7):794-9. doi: 10.1001/archotol.129.7.794.
Nasopharyngeal cancer (NPC) is a distinct form of cancer of the upper respiratory or digestive tract in which the epidemiologic features, origin, histopathologic types, treatment, and prognosis are different from those associated with other malignant neoplasms of this anatomical area. Recent publications have demonstrated the advantage of aggressive multimodality treatment for advanced NPC.
To evaluate the results of standardized treatment of NPC during 11 years and to identify pertinent factors for clinical outcome.
Between January 1, 1989, and December 31, 2000, 173 patients with newly diagnosed NPC were treated at Instituto Nacional de Cancer. Clinical records and radiographic studies of the patients were retrospectively reviewed. Documented data of the initial presenting symptoms, head and neck examination, radiotherapy protocols, chemotherapy regimens, and surgical technique were analyzed. To determine important prognostic factors, we correlated survival rates with age, clinical stage, tumor extent, histopathological type, and therapeutic approach. The major end point used for assessment was relapse-free survival. Survival curves were estimated by the Kaplan-Meier product-limit method. Multivariate analysis was performed using the Wilcoxon signed rank and Cox proportional hazards regression tests.
Most patients (88.5%) had locoregional advanced disease, mostly (53.4%) of the nonkeratinizing subtype. Forty-seven percent of patients had clinical cervical nodal metastases at first consultation. Gross extension of the primary tumor involving the facial bones and skull base was observed in 39.3% and 20.8%, respectively. Just under 75% of patients were treated with radiotherapy (median dose, 6600 cGy), and 25.4% underwent concomitant chemoradiotherapy with adjuvant chemotherapy (cisplatin plus 5-fluorouracil) (median dose, 6800 cGy). The 5-year disease-specific survival for the 173 patients was 32.3%. The disease-specific survival for the radiotherapy group was 22.5%, compared with 61.4% for the chemoradiotherapy plus adjuvant chemotherapy group (P =.004). Factors associated with adverse outcomes were age older than 40 years at treatment (P =.001), advanced TNM stage (P =.002), skull base invasion (P =.004), and facial bone invasion (P<.001).
Compared with radiotherapy alone, concomitant chemoradiotherapy with adjuvant chemotherapy improved the treatment outcome of patients with NPC treated in our institution. Advanced age, local extension, and stage of the disease adversely affected the prognosis in our patients. Compared with reirradiation, salvage brachytherapy and radical neck dissection for local and regional residual or recurrent NPC were associated with increased rates of locoregional control and survival.
鼻咽癌（NPC）是上呼吸道或消化道的一种特殊类型癌症，其流行病学特征、起源、组织病理学类型、治疗方法及预后与该解剖区域的其他恶性肿瘤不同。近期发表的文献已证明积极的多模式治疗对晚期鼻咽癌的优势。
评估11年间鼻咽癌标准化治疗的结果，并确定影响临床结局的相关因素。
1989年1月1日至2000年12月31日期间，国立癌症研究所治疗了173例新诊断的鼻咽癌患者。对患者的临床记录和影像学研究进行回顾性分析。分析记录的初始症状、头颈部检查、放疗方案、化疗方案及手术技术等数据。为确定重要的预后因素，将生存率与年龄、临床分期、肿瘤范围、组织病理学类型及治疗方法进行关联分析。评估的主要终点为无复发生存率。采用Kaplan-Meier乘积限界法估计生存曲线。使用Wilcoxon符号秩检验和Cox比例风险回归检验进行多变量分析。
大多数患者（88.5%）患有局部区域晚期疾病，多数（53.4%）为非角化亚型。47%的患者初诊时伴有临床颈部淋巴结转移。分别观察到39.3%和20.8%的原发肿瘤有累及面骨和颅底的大体扩展。略低于75%的患者接受了放疗（中位剂量6600 cGy），25.4%的患者接受了同步放化疗及辅助化疗（顺铂加5-氟尿嘧啶）（中位剂量6800 cGy）。173例患者的5年疾病特异性生存率为32.3%。放疗组的疾病特异性生存率为22.5%，而同步放化疗加辅助化疗组为61.4%（P = 0.004）。与不良结局相关的因素包括治疗时年龄大于40岁（P = 0.001）、TNM分期晚期（P = 0.002）、颅底侵犯（P = 0.004）及面骨侵犯（P<0.001）。
与单纯放疗相比，同步放化疗加辅助化疗改善了我院治疗的鼻咽癌患者的治疗结局。高龄、局部扩展及疾病分期对我院患者的预后有不利影响。与再次放疗相比，挽救性近距离放疗及根治性颈淋巴结清扫术用于局部和区域残留或复发鼻咽癌时，局部区域控制率和生存率更高。
