鼻咽癌腮腺淋巴结转移危险因素及高危患者腮腺局部调强放疗的探讨

doi:10.3760/cma.j.issn.1004-4221.2019.09.003

摘要
图/表
参考文献()
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (0 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的探讨鼻咽癌腮腺淋巴结转移的高危因素,评价高危者腮腺放疗的可行性。方法收集2011-2017年江苏省肿瘤医院放疗科收治的440例初诊鼻咽癌患者的临床资料,回顾性分析腮腺淋巴结转移相关的影像特点、治疗及预后。全组采用调强放疗技术,全腮腺或部分腮腺照射、选择性PLN照射,X线和(或)电子线补量,剂量45~60 Gy。χ²检验或Fisher's精确概率法检验和单因素分析,Logistic回归模型多因素分析。Kaplan-Meier法生存分析,Logrank检验差异。结果腮腺区影像学可见淋巴结者共230例。确诊腮腺转移11例(占2.5%,11/440),其中腮腺淋巴结最大径≥5 mm者占81.8%(9/11)。多因素分析显示Ⅱ区淋巴结包膜外侵为其转移的独立危险因素。将腮腺区淋巴结最大径≥5 mm、Ⅱ区淋巴结包膜外侵者筛选为腮腺淋巴结转移高危组,根据腮腺区是否放疗分为放疗组及未放疗组。生存分析发现,在230例患者中,高危组腮腺区放疗者与未放疗者无局部复发生存率不同(P<0.05),总生存、无远处转移生存、无进展生存均相近(P>0.05)。结论鼻咽癌腮腺淋巴结转移率低,Ⅱ区淋巴结包膜外侵为其独立高危因素。对于腮腺淋巴结最大径≥5 mm,或腮腺区存在影像学可见淋巴结,即使其最大径<5 mm,但若合并Ⅱ区淋巴结包膜外侵,建议行腮腺区放疗。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	张永芹
	左云
	问静
	王丽君
	张兰芳
	黄生富

关键词 ：鼻咽肿瘤, 腮腺淋巴结转移/放射疗法, 预后

Abstract：Objective To investigate the high-risk factors for parotid lymph node (PLN) metastasis from nasopharyngeal carcinoma (NPC) and evaluate the feasibility of local intensity-modulated radiotherapy (IMRT) in patients with high-risk NPC. Methods Clinical data of 440 NPC patients admitted to Department of Radiotherapy of Jiangsu Cancer Hospital from May,2011 to March,2017 were collected. The imaging features,treatment strategies and clinical prognosis of PLN metastasis were retrospectively analyzed. The whole group adopts the technique of intensity modulated radiotherapy. Total parotid or partial parotid irradiation, selective PLN irradiation, X-Ray and/or electronic line supplementation, dose 45-60 Gy. The χ² test or Fisher's accurate probability method test and single factor analysis,Logistic regression model multi-factor analysis. Kaplan-Meier survival analysis,log-rank test differences. Results PLN was observed in the parotid of 230 cases. At the end of follow-up,11 patients (2.5%,11/440) were diagnosed with PLN metastases. Among 11 cases,9 patients (81.8%) had PLN size ≥5 mm. Multivariate analysis demonstrated that extracapsular spread of level Ⅱ was an independent risk factor for PLN metastasis. The patients with PLN size ≥5 mm or extracapsular spread of level Ⅱ were assigned into the high-risk PLN metastasis group. The patients in the high-risk group were further divided into the radiotherapy and non-radiotherapy subgroups. Survival analysis demonstrated that for 230 patients with PLN metastasis,the local recurrence-free survival (LRFS) significantly differed,whereas the overall survival (OS),disease metastasis-free survival (DMFS) and progression-free survival (PFS) did not considerably differ between the radiotherapy and non-radiotherapy subgroups in the high-risk PLN metastasis patients. Conclusions The PLN metastasis rate of NPC is low. Extracapsular spread of level Ⅱ is an independent risk factor. Radiotherapy of the parotid region is considered for patients with PLN size≥5 mm or those with PLN size<5 mm complicated with extracapsular spread of level Ⅱ.

Key words： Nasopharyngeal neoplasms,parotid lymph node metastasis/radiotherapy Prognosis

收稿日期: 2018-06-14

基金资助:江苏省肿瘤医院院课题(ZN201612)

通讯作者: 黄生富,Email:hsf200902@163.com

引用本文:

张永芹,左云,问静等. 鼻咽癌腮腺淋巴结转移危险因素及高危患者腮腺局部调强放疗的探讨[J]. 中华放射肿瘤学杂志, 2019, 28(9): 652-656.

Zhang Yongqin,Zuo Yun,Wen Jing et al. The risk factors of parotid lymph node metastasis of nasopharyngeal carcinoma and the feasibility of local intensity-modulated radiotherapy for high-risk patients[J]. Chinese Journal of Radiation Oncology, 2019, 28(9): 652-656.

链接本文:

http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2019.09.003 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2019/V28/I9/652

[1] 罗京伟,徐国镇,高黎,等. 鼻咽癌调强放疗后的少见治疗失败方—腮腺转移[J]. 中华放射肿瘤学杂志,2007,(2):154. DOI:10.3760/j.issn:1004-4221.2007.02.018.
Luo JW,Xu GZ,Gao L,et al. The rare failure after intensity-modulated radiotherapy in nasopharyngeal carcinoma patients—parotid metastasis[J]. Chin J Radit Oncol,2007,(2):154. DOI:10.3760/j.issn:1004-4221.2007.02.018.
[2] 邹育超. 鼻咽癌调强放疗后腮腺淋巴结转移临床分析[J]. 医学信息,2014(21):300-300. DOI:10.3969/j.issn.1006-1959.2014.21.354.
Zou YC. Clinical analysis of parotid metastasis of nasopharyngeal carcinoma patients after intensity-modulated radiotherapy[J]. Med Informat, 2014(21):300-300. DOI:10.3969/j.issn.1006-1959.2014.21.354.
[3] Donald M. Cannon,Nancy Y. Lee. Recurrence in region of spared parotid gland after definitive intensity-modulated radiotherapy for Head and neck Cancer[J]. Int J Radiat Oncol Biol Phys,2008,70(3):660-665. DOI:10.1016/j.ijrobp.2007.09.018.
[4] Lin DS,Jen YM,Lee JC,et al. Recurrence of nasopharyngeal carcinoma in the parotid region after parotid-gland-sparing radiotherapy[J]. J Formos Med Assoc,2011,110(10):655-660. DOI:10.1016/j.jfma.2011.08.009.
[5] Cao CN,Luo JW,Gao L,et al. Clinical characteristics and patterns of failure in the parotid region after intensity-modulated radiotherapy for nasopharyngeal carcinoma[J]. Oral Oncol,2013,49(6):611-614. DOI:10.1016/j.oraloncology.2013.02.001.
[6] Xu Y,Zhang M,Xiao Y,et al. Parotid area lymph node metastases from preliminarily diagnosed patients with nasopharyngeal carcinoma:report on tumor characteristics and oncologic outcomes[J]. Oncotarget,2016,7(15):19654-65. DOI:10.18632/oncotarget.7677.
[7] Zhang Y,Li WF,Chen L,et al. Prognostic value of parotid lymph node metastasis in patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy[J]. Sci Rep,2015,5:13919. DOI:10.1038/srep13919.
[8] Grégoire V,Ang K,Budach W,et al. Delineation of the neck node levels for head and neck tumors:a 2013 update. DAHANCA,EORTC,HKNPCSG,NCIC CTG,NCRI,RTOG,TROG consensus guidelines[J]. Radiother Oncol,2014,110(1):172-181. DOI:10.1016/j.radonc.2013.10.010.
[9] 中国鼻咽癌临床分期工作委员会. 鼻咽癌'92分期修订工作报告[J]. 中华放射肿瘤学杂志,2009,18(1):2-6. DOI:10.3760/cma.j.issn.1004-4221.2009.01.002.
Chinese Committee for Staging of Nasopharyngeal Carcinoma. Report on revision of the Chinese 1992 staging system for nasopharyngeal carcinoma[J]. Chin J Radit Oncol,2009,18(1):2-6. DOI:10.3760/cma.j.issn.1004-4221.2009.01.002.
[10] 高云生,胡超苏,应红梅,等.1837例鼻咽癌疗效的回顾性分析[J]. 中华放射肿瘤学杂志,2008,17(5):335-339. DOI:10.3321/j.issn:1004-4221.2008.05.002.
Gao YS,Hu CS,Ying HM,et al. Treatment results of nasopharyngeal carcinoma:a retrospective analysis of 1837 cases in a single institute[J]. Chin J Radit Oncol,2008,17(5):335-339. DOI:10.3321/j.issn:1004-4221.2008.05.002.
[11] 潘建基,张瑜,林少俊,等.1706例鼻咽癌放疗远期疗效分析[J]. 中华放射肿瘤学杂志,2008,17(4):247-251. DOI:10.3321/j.issn:1004-4221.2008.04.001.
Pan JJ,Zhang Y,Lin SJ,et al. Long-term results of asopharyngeal carcinoma treated with radiotherapy:1706 cases report[J]. Chin J Radit Oncol,2008,17(4):247-251. DOI:10.3321/j.issn:1004-4221.2008.04.001.
[12] McKean ME,Lee K,McGregor IA. The distribution of lymph nodes in and around the parotid gland:an anatomical study[J]. Br J Plast Surg,1985,38(1):1-5.
[13] Ng SH,Chang JT,Chan SC,et al. Nodal metastases of nasopharyngeal carcinoma:patterns of disease on MRI and FDG PET[J]. Eur J Nucl Med Mol Imaging,2004,31(8):1073-1080. DOI:10.1007/s00259-004-1498-9.
[14] Wang X,Hu C,Ying H,et al. Patterns of lymph node metastasis from nasopharyngeal carcinoma based on the 2013 updated consensus guidelines for neck node levels[J]. Radiother Oncol,2015,115(1):41-45. DOI:10.1016/j.radonc.2015.02.017.
[15] Chong VF,Fan YF. Paroti d gland involvement in nasopharyngeal carcinoma[J]. J Comput Assist Tomogr,1999,23(4):524-528.
[16] Kim DY,Joo JK,Ryu SY,et al. Clinicopathologic characteristics of gastric carcinoma in elderly patients:a comparison with young patients[J]. World J Gastroenterol,2005,11(1):22-26. DOI:10.3748/wjg.v11.il.22.
[17] Smith BR¹,Stabile BE. Extreme aggressiveness and lethality of gastric adenocarcinoma in the very young[J]. Arch Surg,2009,144(6):506-510. DOI:10.1001/archsurg.2009.77. DOI:10.1001/archsurg.2009.77.
[18] Ho FC,Tham IW,Earnest A,et al. Patterns of regional lymph node metastasis of nasopharyngeal carcinoma:a meta-analysis of clinical evidence[J]. BMC Cancer,2012,12(1):98. DOI:10.1186/1471-2407-12-98.