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局部区域控制对鼻咽癌远处转移扩散的影响：1301例患者的分析

The effect of loco-regional control on distant metastatic dissemination in carcinoma of the nasopharynx: an analysis of 1301 patients.

作者信息

Kwong D, Sham J, Choy D

机构信息

Department of Radiotherapy and Oncology, Queen Mary Hospital, Hong Kong.

出版信息

Int J Radiat Oncol Biol Phys. 1994 Dec 1;30(5):1029-36. doi: 10.1016/0360-3016(94)90306-9.

DOI:10.1016/0360-3016(94)90306-9
PMID:7961008
Abstract

PURPOSE

This study evaluated the effect of loco-regional control on incidence of distant metastases in patients with nasopharyngeal carcinoma.

METHODS AND MATERIALS

Retrospective analysis was performed on 1301 patients with nasopharyngeal carcinoma treated from 1976-1989 in our hospital. The effect of different prognostic indicators on distant metastases free survival (DMFS) was analyzed, including T stage, N stage, sex, and loco-regional control. The significance of loco-regional control in distant metastatic dissemination was further studied with period and subgroup analysis. Cox regression was performed to identify the independent prognostic variables.

RESULTS

Patients with loco-regional relapse had significantly higher distant metastases rate than patients with loco-regional control (time-adjusted distant metastases rate at 5 years was 40.7% vs. 29.4%, p = 0.0012). By period analysis, the effect of loco-regional control on distant metastases was found to be significant in the first 2 years from diagnosis. Subgroup analysis showed that loco-regional relapse was associated with significantly higher distant metastases rate in patients with T1, N0, and N1 disease (p = 0.001, 0.001, 0.0226, respectively). The Cox regression model also confirmed loco-regional control as an independent prognostic indicator of distant metastases (p = 0.0001) besides T stage (p = 0.0006) and N stage (p = 0.0001).

CONCLUSION

Loco-regional relapse is a significant risk factor for development of distant metastases. Further effort should be made to improve loco-regional control and to eradicate distant metastases.

摘要

目的

本研究评估了局部区域控制对鼻咽癌患者远处转移发生率的影响。

方法与材料

对1976年至1989年在我院接受治疗的1301例鼻咽癌患者进行回顾性分析。分析了不同预后指标对无远处转移生存期（DMFS）的影响，包括T分期、N分期、性别和局部区域控制。通过时期分析和亚组分析进一步研究局部区域控制在远处转移扩散中的意义。进行Cox回归以确定独立的预后变量。

结果

局部区域复发的患者远处转移率显著高于局部区域得到控制的患者（5年时间调整后的远处转移率分别为40.7%和29.4%，p = 0.0012）。通过时期分析发现，局部区域控制对远处转移的影响在诊断后的前2年具有显著性。亚组分析显示，在T1、N0和N1期疾病患者中，局部区域复发与显著更高的远处转移率相关（p分别为0.001、0.001、0.0226）。Cox回归模型也证实，除了T分期（p = 0.0006）和N分期（p = 0.0001）外，局部区域控制是远处转移的独立预后指标（p = 0.0001）。

结论

局部区域复发是远处转移发生的重要危险因素。应进一步努力改善局部区域控制并根除远处转移。

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