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目的:探讨鼻咽癌扩散类型与远处转移的相关性。方法:回顾性分析260例初治鼻咽癌患者的临床资料,其中发生远处转移(转移组)162例,放疗后≥5年无复发或远处转移(无瘤组)98例。结合治疗前CT或MRI,重新确定T、N分期,把所有患者分为局限型(T1～2N0～1)36例、上行型(T3～4N0～1)68例、下行型(T1～2N2～3)75例和混合型(T3～4N2～3)81例,对两组间差异进行比较分析。结果:转移组患者中,局限型和上行型仅占25.3%,下行型和混合型占74.7%,无瘤组则分别为64.3%和35.7%(均P<0.01)。在原发灶为局限病变的患者中,N2～3患者占转移组的84.4%,无瘤组为33.3%,差异有统计学意义(P<0.01)。原发灶严重扩散的患者(T3～4)中,无瘤组N0～1为60%,N2～3为40%,转移组则分别为31.6%和68.4%,两组差异有统计学意义(均P<0.01)。结论:颈部淋巴结转移程度与鼻咽癌发生远处转移密切相关,原发灶的严重扩散也不可忽视;即使是局限性病变,一旦发生严重颈部转移,其远处转移危险性明显增加。
Objective: To investigate the relationship between the types of nasopharyngeal carcinoma and distant metastasis. Methods: The clinical data of 260 newly diagnosed nasopharyngeal carcinoma patients were retrospectively analyzed. There were 162 cases of distant metastasis (metastasis group) and 98 cases of no recurrence or distant metastasis (no tumor group) ≥ 5 years after radiotherapy. All patients were divided into three groups: 36 cases of T1 ~ 2N0 ~ 1, 68 cases of T3 ~ 4N0 ~ 1, T1 ~ 2N2 ~ 3) 75 cases and mixed type (T3 ~ 4N2 ~ 3) 81 cases, the differences between the two groups were analyzed. Results: Only 25.3% of the patients in the metastatic group had localized and upward type, 74.7% in the down and mixed type, and 64.3% and 35.7% in the non-tumor group (all P <0.01). Among patients with primary lesion, N2 ~ 3 accounted for 84.4% in the metastatic group and 33.3% in the non-neoplastic group, with significant difference (P <0.01). In patients with severe primary tumor spread (T3 ~ 4), N0 ~ 1 was 60%, N2 ~ 3 was 40% in the tumor-free group and 31.6% and 68.4% in the metastatic group, respectively All P <0.01). CONCLUSION: The degree of cervical lymph node metastasis is closely related to the distant metastasis of nasopharyngeal carcinoma. The severe spread of primary tumor can not be neglected. Even if it is a localized disease, the risk of distant metastasis increases significantly when severe neck metastasis occurs.