Observation on clinical efficacy and prognosis analysis of endoscopic surgery treatment for rT1-rT2 recurrent nasopharyngeal carcinoma
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摘要: 目的:探讨采用经鼻内镜手术治疗rT1~rT2复发鼻咽癌的可行性。方法:回顾性分析2011-02-2015-12期间57例鼻咽癌治疗后原发灶复发的患者的临床资料及治疗情况。术前按国际抗癌联盟UICC(2010)鼻咽癌分期方案重新分期,同意手术者行鼻内镜手术切除鼻咽部病灶,伴有颈部淋巴结转移灶者同时行颈部淋巴结清扫术,鼻咽部病灶手术切缘阳性者及颈部淋巴结膜外浸润者术后行放疗联合化疗;不同意手术者直接行放疗联合化疗。所有患者定期随访,观察临床疗效及生存情况。结果:57例患者中Ⅰ期19例,Ⅱ期30例,Ⅲ期6例,Ⅳ期2例,其中rT1期27例,rT2期30例;rN0期43例,rN1期6例,rN2期6例,rN3期2例。经鼻内镜手术切除原发灶44例,其中鼻咽部原发灶手术切缘阳性6例,颈部淋巴结膜外浸润4例,术后均行放疗联合化疗;直接行放疗联合化疗者13例。中位随访时间36个月,57例患者的3年总生存率为61.4%,其中Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者的3年总生存率分别为73.7%、63.3%、33.3%、0.0%,Kaplan-Meier生存曲线分析表明不同分期的患者总生存率差异有统计学意义(P=0.002)。rT1和rT2患者的3年总生存率分别为63.0%、60.0%,Kaplan-Meier生存曲线分析显示,rT1与rT2患者总生存率差异无统计学意义(P=0.707)。rN0、rN1、rN2、rN3患者的3年总生存率分别为69.8%、50.0%、33.3%、0.0%,Kaplan-Meier生存曲线分析显示,不同rN分期患者的总生存率差异有统计学意义(P=0.002)。44例手术患者的3年总生存率为68.2%,13例非手术患者的3年总生存率为38.5%,Kaplan-Meier生存曲线分析显示,手术与非手术患者的总生存率差异有统计学意义(P=0.014)。结论:采用经鼻内镜治疗复发性鼻咽癌是安全和有效的治疗方式,可提高患者的生存率。Abstract: Objective: To investigate the feasibility of endoscopic surgery for treatment of rT1-rT2 recurrent nasopharyngeal carcinoma. Method: The clinical data and of 57 patients who had recurrence of the primary lesion after treatment of nasopharyngeal carcinoma from February 2011 to December 2015 were retrospectively analyzed. The patients were re-staged according to Union for International Cancer Control(UICC, 2010) staging system for nasopharyngeal carcinoma before surgery. Patients suitable for surgery underwent endoscopic surgery to remove nasopharyngeal lesions; those combined with cervical lymph node metastases underwent cervical lymph node dissection at the same time; patients with positive surgical margins of pharyngeal lesions and cervical lymph node extramembranous filtration were treated with radiotherapy combined with chemotherapy; patients unsuitable for surgery were treated with radiotherapy combined with chemotherapy directly. All patients were followed up regularly to observe clinical efficacy and survival. Result: Fifty-seven patients were re-staged according to UICC(2010) staging system for nasopharyngeal carcinoma: 19 cases in stage Ⅰ, 30 cases in stage Ⅱ, 6 cases in stage Ⅲ and 2 cases in stage Ⅳ, including 27 cases in stage rT1, 30 cases in stage rT2, and 43 cases in stage rN0, 6 cases in stage rN1, 6 cases in stage rN2, 2 cases in stage rN3. Forty-four cases of primary lesions were sected for endoscopic surgery. Patients combined with cervical lymph node metastases underwent cervical lymph node dissection at the same time, with 6 cases of positive surgical margins of pharyngeal lesions and 4 cases of cervical lymph node extramembranous infiltration, who were treated with radiotherapy combined with chemotherapy after surgery. Thirteen patients received radiotherapy combined with chemotherapy directly. At a median follow-up of 36 months, the 3-year overall survival rate of 57 patients was 61.4%. The 3-year overall survival rates of patients in stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 73.7%, 63.3%, 33.3%, 0.0% respectively. Kaplan-Meier survival curve analysis showed a significant difference in the overall survival rate of patients in different stages(P=0.002). The 3-year overall survival rates of rT1 and rT2 patients were 63.0%, 60.0% respectively, and Kaplan-Meier survival curve analysis showed no significant difference in the overall survival rate between rT1 and rT2 patients(P=0.707). The 3-year overall survival rates of patients in stages rN0, rN1, rN2, rN3 were 69.8%, 50.0%, 33.3%, 0.0% respectively, and Kaplan-Meier Survival curve analysis showed a significant difference in overall survival between patients in different rN stages(P=0.002). The 3-year overall survival rate was 68.2% in 44 surgical patients, and 38.5% in 13 non-surgical patients. Kaplan-Meier survival curve analysis showed significant difference in overall survival rate between surgical and non-surgical patients(P=0.014).Conclusion: Endoscopic surgery for recurrent nasopharyngeal carcinoma is a safe and effective treatment to improve survival.
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Key words:
- nasopharyngeal neoplasms /
- recurrence /
- endoscopy /
- radiotherapy
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