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目的分析放疗联合化疗治疗海南地区鼻咽癌患者的预后情况。方法回顾性分析2011年1~12月期间在本院就诊且有完整随访资料的79例海南地区鼻咽癌患者的临床资料,Kaplan-Meier法计算生存率,并Log-rank法检验。结果本组79例患者的3年总生存率、无病生存率、无局部区域复发生存率、无远处转移生存率分别为78.5%、66.7%、92.8%、74.1%。30例治疗失败病例中有5例复发,22例远处转移,3例致死性治疗相关并发症。转移部位为骨、肺、肝,以骨转移最多见。20例死亡病例中死于远处转移15例,颅内复发2例,治疗并发症3例。远处转移占失败病例的73.3%,占死亡病例的75.0%。T分期是无复发生存的独立预后因素,N分期是影响总生存和无远处转移生存的独立预后因素,临床分期是总生存的独立预后因素。同期放化疗组和同期放化疗+辅助化疗组3年总生存率分别为81.5%、62.1%,差异无统计学意义(χ2=2.007,P>0.05)。结论远处转移是鼻咽癌治疗失败的主要原因;N分期是无远处转移生存的独立预后因素,在同期放化疗基础上,加辅助化疗并未提高生存率。
Objective To analyze the prognosis of patients with nasopharyngeal carcinoma in Hainan by radiotherapy combined with chemotherapy. Methods The clinical data of 79 patients with nasopharyngeal carcinoma in Hainan from January to December in 2011 with complete follow-up data were retrospectively analyzed. Kaplan-Meier method was used to calculate the survival rate and Log-rank test. Results The overall 3-year survival rate, disease-free survival rate, local recurrence-free survival rate and distant metastasis-free survival rate of 79 patients in this group were 78.5%, 66.7%, 92.8% and 74.1%, respectively. Among the 30 cases of treatment failure, 5 were relapsed, 22 were distant metastases, and 3 were fatal-related complications. Metastatic sites for the bone, lung, liver, the most common bone metastases. Among the 20 deaths, 15 died of distant metastasis, 2 had intracranial recurrence and 3 had complications. Remote metastasis accounted for 73.3% of failed cases, accounting for 75.0% of deaths. T staging is an independent prognostic factor for recurrence-free survival. N staging is an independent prognostic factor affecting overall survival and distant metastasis-free survival. Clinical staging is an independent prognostic factor for overall survival. The 3-year overall survival rates of concurrent chemoradiotherapy and concurrent chemoradiotherapy plus adjuvant chemotherapy were 81.5% and 62.1%, respectively, with no significant difference (χ2 = 2.007, P> 0.05). Conclusion Distant metastasis is the main reason for the failure of nasopharyngeal carcinoma treatment. N stage is an independent prognostic factor for distant metastasis-free survival. On the basis of concurrent chemoradiotherapy, adjuvant chemotherapy did not improve the survival rate.