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[目的]分析Ⅳa期鼻咽癌患者的预后及影响预后的因素。[方法]将99例Ⅳa期鼻咽癌纳入分析。Kaplan-Meier法计算生存数据,并对Ⅳa期鼻咽癌的预后相关因素行单因素和多因素分析。[结果]全组病例3年局部控制率、无远处转移生存率、无进展生存率、疾病相关总生存率分别为87.3%、75.8%、69.3%及77.9%,远处转移是治疗失败主要原因。单因素分析提示N分期较晚患者(N2～3)其生存显著低于N分期较早者(P<0.05)。多因素分析提示N分期较晚影响Ⅳa期病例远处转移发生,但无统计学差异(N0～1vs.N2～3,HR=0.396,95%CI:0.144～1.086,P=0.072)。N2～3的Ⅳa期患者其无远处转移生存和无进展生存率显著低于N0～1的Ⅳa期患者(P=0.023,P=0.011),局部控制率则无显著差异(P=0.432)。[结论]中国鼻咽癌2008分期中Ⅳa期病例预后具有很大的不一致性,主要由颈部淋巴结分期的早晚决定。
[Objective] To analyze the prognosis and prognostic factors of patients with stage Ⅳa nasopharyngeal carcinoma. [Method] 99 cases of stage Ⅳa nasopharyngeal carcinoma were included in the analysis. Survival data were calculated by Kaplan-Meier method, and univariate and multivariate analyzes were performed on the prognostic factors of stage Ⅳa nasopharyngeal carcinoma. [Results] The 3-year local control rate, distant metastasis-free survival rate, progression-free survival rate and disease-related total survival rate were 87.3%, 75.8%, 69.3% and 77.9% in all the cases. The distant metastasis was the main cause of treatment failure the reason. Univariate analysis showed that the survival of patients with late N stage (N2 ~ 3) was significantly lower than that of N stage (P <0.05). Multivariate analysis showed that the late stage of N staging affected distant metastasis in stage Ⅳa, but there was no significant difference (N0 ~ 1vs.N2 ~ 3, HR = 0.396, 95% CI: 0.144 ~ 1.086, P = 0.072). The patients with stage Ⅳa of N2 ~ 3 had no significant difference in the survival rate of distant metastasis and progression-free survival (P = 0.023, P = 0.011) compared with N0-1 stage Ⅳa patients (P = 0.432) . [Conclusion] The prognosis of stage Ⅳa nasopharyngeal carcinoma in 2008 staging is very inconsistent, mainly determined by the stage of cervical lymph node staging.