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目的:探讨鼻咽癌患者治疗后发生远处转移的影响因素,建立远处转移的预测模型。方法:收集鼻咽癌治疗后发生远处转移的158例住院患者临床资料,采用Cox回归模型分析远处转移的影响因素。建立远处转移危险指数方程(IE),根据IE值将全部患者分为不同的危险组,采用Log-rank检验进行分析。结果:单因素分析显示,T分期、N分期、临床分期、颈淋巴结转移和颈部放疗剂量影响治疗后远处转移(χ2值分别为29.63、54.83、58.42、24.86和5.91,P均<0.05),临床分期分层分析结果显示,Ⅲ、Ⅳ期鼻咽癌患者化疗与否无远处转移生存曲线分离,χ2值分别为4.42、3.93,P均<0.05。多因素分析表明,N分期、临床分期和化疗是影响鼻咽癌治疗后远处转移的独立因素(β值分别为0.435、0.761、0.697,P均<0.01),不同危险组无远处转移生存率差异有统计学意义,P<0.01。结论:IE值能较客观地预测远处转移的危险性,为临床进行个体化治疗提供参考。
Objective: To investigate the influential factors of distant metastasis in patients with nasopharyngeal carcinoma after treatment and to establish a prediction model of distant metastasis. Methods: The clinical data of 158 hospitalized patients with distant metastasis after NPC were collected. The influencing factors of distant metastasis were analyzed by Cox regression model. The risk index equation of distant metastasis (IE) was established. According to IE value, all patients were divided into different risk groups and analyzed by Log-rank test. Results: Univariate analysis showed that distant metastasis (29.63, 54.83, 58.42, 24.86 and 5.91, respectively, P <0.05) was affected by T stage, N stage, clinical stage, cervical lymph node metastasis and neck radiotherapy dose. The results of stratified clinical staging showed that the survival curves of patients with stage Ⅲ and Ⅳ nasopharyngeal carcinoma were not significantly different from those without metastasis (χ2 = 4.42 and 3.93, respectively, P <0.05). Multivariate analysis showed that N staging, clinical staging and chemotherapy were the independent factors influencing the distant metastasis of nasopharyngeal carcinoma after treatment (β values were 0.435, 0.761 and 0.677, respectively, P <0.01), and there was no distant metastasis in different risk groups Rate difference was statistically significant, P <0.01. Conclusion: The value of IE can predict the risk of distant metastasis objectively, and provide a reference for the individualized treatment in clinic.