中华放射医学与防护杂志

郑宝敏,刘颖.咽后淋巴结转移在鼻咽癌调强放疗预后中的意义[J].中华放射医学与防护杂志,2014,34(1):34-36

咽后淋巴结转移在鼻咽癌调强放疗预后中的意义

Prognostic value of retropharyngeal lymph nodes in nasopharyngeal carcinoma treated by intensity modulated radiotherapy (IMRT)

投稿时间：2013-08-01

DOI：10.3760/cma.j.issn.0254-5098.2014.01.009

中文关键词: 鼻咽癌咽后淋巴结淋巴结坏死淋巴结转移调强放疗

英文关键词:Nasopharyngeal carcinoma Retropharyngeal lymph node Necrosis of lymph node Metastasis of lymph node Intensity modulated radiotherapy

基金项目:

作者	单位
郑宝敏	100142 北京大学肿瘤医院放疗科
刘颖	100142 北京大学肿瘤医院放疗科

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中文摘要:

目的探讨鼻咽癌咽后淋巴结阳性率和坏死率与临床疗效的关系，为制定综合治疗方案提供参考。方法选取2004年8月至2007年3月接受调强放疗的72例鼻咽癌患者，在CT定位图像上勾画咽后淋巴结及坏死区，计算坏死区体积，分析咽后淋巴结阳性率及坏死率与临床相关因素的关系。结果颈部淋巴结转移率为90.3%，其中，Ⅰ区转移率为2.8%，Ⅱ区为86.0%，Ⅲ区为51.4%，Ⅳ区为20.8%，Ⅴ区为37.5%。咽后淋巴结转移率为79.2%，咽后淋巴结交叉转移率为6.9%。咽后淋巴结阳性者中，左侧出现坏死占21.6%，右侧出现坏死占27.2%，双侧均出现坏死占15.4%。咽后淋巴结转移与N分期和临床分期有明显相关性（福州92分期，r=0.383、-0.314，P<0.05；UICC分期，r=-0.434、-0.306，P<0.05）。中位随访时间36个月，4例出现复发，6例出现远处转移，死亡7例。咽后淋巴结阳性与复发率、远处转移率及生存率、无病生存率明显相关（r=0.085、0.138、-0.140、-0.124，P<0.05）；咽后淋巴结坏死与复发率、远处转移率相关（r=0.256、-0.057，P<0.05），与生存率和无病生存率无明显相关。结论咽后淋巴结转移与N分期和临床分期相关，主要是同侧转移，交叉转移比例低。咽后淋巴结阳性和鼻咽癌局部复发率、远处转移率及生存率明显相关。咽后淋巴结坏死与鼻咽癌调强放疗后局部复发率、远处转移率明显相关，与总生存率、无病生存率相关性不明确，需进一步随访观察。

英文摘要:

Objective To investigate the correlation of the the positive rate and necrosis rate of retropharyngeal lymph nodes with the clinical effects of intensity modulated radiotherapy (IMRT) in treatment of nasopharyngeal carcinoma (PNC). Methods Seventy-two patients with PNC, 50 males and 22 females, with the median age of 50, underwent IMRT delivered into 33 times. The retropharyngeal lymph nodes involved and positive lymph nodes of neck were delineated on the CT image. The median dose and median fractionated dose for gross tumor volume (GTV) were 70.0 and 2.12 Gy respectively, and the median dose and median fractionated dose for clinical target volume (CTV) were 70.0 and 2.12 Gy respectively. The patients were followed up for 36 (5-54) months. Results The metastasis rate of the neck lymph nodes was 90.3%, the metastasis rates in the regions Ⅰ-Ⅴ were 2.8%, 86.0%, 51.4%, 20.8%, and 37.5%, respectively. The metastasis rate of the retropharyngeal lymph nodes was 79.2%, and specifically the metastasis rates of the left, right, and bilateral retropharyngeal lymph nodes were 51.4%, 45.9%, and 18.1%, respectively. The cross metastasis rate was 6.9%. Necrosis of the retropharyngeal lymph nodes was found in 15 cases. The necrosis rates of the left, right, and bilateral retropharyngeal lymph nodes were 21.6%, 27.2%, 15.4%, respectively. Retropharyngeal lymph nodes metastasis was significantly correlated with N stage and clinical stage(Fuzhou 92:r=-0.383,-0.314,P<0.05;UICC:r=-0.434,-0.306,P<0.05).Local recurrence was observed in 4 patients, 6 patients had distant metastasis, and 7 patients died. The positiveness of retropharyngeal lymph nodes was significantly correlated with the recurrence rate, distant metastasis rate, survival rate, and disease free survival rate (r=0.085, 0.138, -0.140, -0.124,P<0.05),and the necrosis of the retropharyngeal lymph nodes was significantly correlated with the recurrence rate and distant metastasis rate (r=0.256, -0.057, P<0.05), and not significantly correlated with the survival rate and disease free survival rate.Conclusions Retropharyngeal lymph nodes metastasis in NPC is correlated with the N stage and clinical stage. The positiveness of retropharyngeal lymph nodes is significantly correlated with local recurrence,distant metastasis, and survival. Necrosis of retropharyngeal lymph nodes in NPC is significantly correlated with local recurrence and distant metastasis after IMRT.

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