Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
Clin Oncol (R Coll Radiol). 2013 Mar;25(3):171-7. doi: 10.1016/j.clon.2012.10.006. Epub 2013 Jan 18.
Nasopharyngeal cancer (NPC) is relatively uncommon, especially in the Western world. We report our single institution experience of 20 years of data in 128 patients with NPC, including responses to different treatment modalities and outcomes by histological subtype.
NPC patients presenting from 1992 to 2005 were located on the cancer registry database. Demographic data included age, gender, length of presenting symptoms and stage. World Health Organization classification (2005) was used for histological subtyping. The date of recurrence and survival outcomes were analysed using Kaplan-Meier curves.
Presentation data were analysed from 128 patients; the survival analysis included 123 patients. The median age at presentation was 57.7 years. Stage III and IV presentation rates were 34 and 38%, respectively. The most common presenting symptom was a palpable neck lump (55%) and the median duration of symptoms was 16 weeks. Forty-eight patients received radiotherapy alone and 75 received chemoradiotherapy. The median overall survival in chemoradiotherapy patients was 80.3 months versus 28.5 months with radiotherapy alone (P = 0.003). A significant difference was also seen with recurrence-free survival (RFS) (P = 0.017). Type 1 keratinising carcinoma had a significantly worse overall survival (P = 0.04) and a similar but non-statistically significant trend was seen for RFS (P = 0.051). The multivariate analysis for overall survival showed that histological subtype (hazard ratio 2.7, 95% confidence interval 1.3-5.5, P = 0.034), age (hazard ratio 2.3, 95% confidence interval 1.1-4.9, P = 0.018) and N stage (hazard ratio 3.7, 95% confidence interval 1.4-9.4, P = 0.024) were prognostic factors.
We present the first large-scale, single-centre retrospective review of NPC in a UK-based population. Demographic data were similar to that in other Western populations, with a significantly worse survival outcome in the keratinising group. Further prospective study of outcome in Western populations accounting for newer radiotherapy techniques such as intensity-modulated radiotherapy and dose escalation, particularly in the keratinising population who were more likely to present with an isolated local recurrence, is recommended.
鼻咽癌（NPC）相对少见，尤其在西方世界。我们报告了本机构 20 年来 128 例 NPC 患者的数据，包括不同治疗方式的反应和组织学亚型的结果。
1992 年至 2005 年就诊的 NPC 患者可在癌症登记数据库中找到。人口统计学数据包括年龄、性别、症状出现时间和分期。采用 2005 年世界卫生组织（WHO）分类法进行组织学亚型分类。采用 Kaplan-Meier 曲线分析复发和生存结局。
分析了 128 例患者的就诊资料；生存分析包括 123 例患者。就诊时的中位年龄为 57.7 岁。III 期和 IV 期就诊率分别为 34%和 38%。最常见的首发症状是可触及的颈部肿块（55%），症状中位持续时间为 16 周。48 例患者仅接受放疗，75 例患者接受放化疗。放化疗患者的中位总生存期为 80.3 个月，而单纯放疗患者为 28.5 个月（P=0.003）。无复发生存率（RFS）也有显著差异（P=0.017）。角化型 1 型癌的总生存率明显较差（P=0.04），RFS 也有类似但无统计学意义的趋势（P=0.051）。总生存率的多变量分析显示，组织学亚型（危险比 2.7，95%置信区间 1.3-5.5，P=0.034）、年龄（危险比 2.3，95%置信区间 1.1-4.9，P=0.018）和 N 分期（危险比 3.7，95%置信区间 1.4-9.4，P=0.024）是预后因素。
我们首次在英国人群中进行了大型单中心回顾性 NPC 研究。人口统计学数据与其他西方人群相似，角化组的生存率明显较差。建议进一步对西方人群的治疗结果进行前瞻性研究，包括新的放疗技术，如调强放疗和剂量递增，特别是角化型患者更有可能出现孤立的局部复发。
