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目的:探讨首程接受常规放射治疗的448例ⅣA期鼻咽癌患者的预后因素。方法:2000-01-01-2004-12-31,首程常规放射治疗ⅣA期(92分期)鼻咽癌448例,其中252例放疗同期联合含顺铂方案的化疗。Kaplan-Meier方法进行单因素分析,Cox比例风险模型进行多因素预后分析。结果:ⅣA期鼻咽癌患者的5年总生存率、局部区域无复发生存率、无远处转移生存率和无瘤生存率分别为52.5%、82.4%、61.9%和51.1%。单因素和多因素分析结果表明,N3是影响总生存率、无远处转移生存率和无瘤生存率的共同预后不良因素。与单纯放疗比较,同期化疗提高了T4N0-2组患者的5年总生存率(66.6%:51.6%;χ2=3.917,P=0.048),但T1-4N3组患者未能从同期化疗中获益。结论:N3分期是影响ⅣA期鼻咽癌总生存率,无远处转移生存率和无瘤生存率的主要不良因素。建议将N3分期患者从ⅣA期中分出另设亚组并在治疗上区别对待。
OBJECTIVE: To investigate the prognostic factors of 448 patients with stage ⅣA nasopharyngeal carcinoma undergoing initial radiotherapy. Methods: The first routine radiotherapy was performed in 448 cases of stage ⅣA (stage 92) nasopharyngeal carcinoma from 2000-01-01-2004-12-31. Of the 252 cases, 252 cases received chemotherapy combined with cisplatin simultaneously. Kaplan-Meier method for univariate analysis, Cox proportional hazards model for multivariate prognostic analysis. Results: The 5-year overall survival rate, recurrence-free survival rate and distant metastasis-free survival rate were 52.5%, 82.4%, 61.9% and 51.1% in patients with stage ⅣA nasopharyngeal carcinoma. Univariate and multivariate analysis showed that N3 was a common adverse prognostic factor affecting the overall survival, distant metastasis-free survival and tumor-free survival. Compared with radiotherapy alone, concurrent chemotherapy increased the 5-year overall survival rate (66.6% vs. 51.6%; χ2 = 3.917, P = 0.048) in patients with T4N0-2, but patients in T1-4N3 group did not benefit from concurrent chemotherapy . Conclusion: N3 staging is a major adverse factor that affects the overall survival rate of NPC in stage ⅣA without distant metastasis and tumor-free survival. Proposed N3 staging patients from the IVA sub-divided into another subgroup and treated differently.