局部晚期鼻咽癌颅底骨质破坏与骨转移的相关性

邹国荣; 黎益华; 曾伟华; 何艳; 龚竹; 曹小龙

doi:10.3971/j.issn.1000-8578.2016.10.006

局部晚期鼻咽癌颅底骨质破坏与骨转移的相关性

Correlation Between Skull Base Invasion and Bone Metastases in Locally Advanced Nasopharyngeal Carcinoma Patients

摘要

摘要:
目的探讨局部晚期鼻咽癌颅底骨质破坏与骨转移的关系。
方法 2008年1月1日至2010年3月31日共518例初治的局部晚期鼻咽癌患者（UICC2002版分期标准分为Ⅲ期、ⅣA期、ⅣB期）入组。按治疗前是否有颅底骨质破坏分为A、B两组：A组（无颅底骨质破坏）243例，B组（有颅底骨质破坏）275例。比较两组患者首次治疗后的骨转移发生率及骨转移时间。
结果 518例骨转移发生率为11.8%（61/518），其中A组16例（6.6%），B组45例（16.4%）（P < 0.05）。在61例发生骨转移患者中，B组单一骨转移发生率明显高于A组（73.3% vs. 43.8%，P < 0.05）；A、B两组出现首次骨转移事件的中位时间分别为14.0月，19.1月，组间比较差异无统计学意义（P > 0.05）。单因素及多因素分析均显示颅底骨质破坏是影响局部晚期鼻咽癌骨转移发生的不良预后因素。
结论伴有颅底骨质破坏的局部晚期鼻咽癌患者易发生骨转移、单一骨转移发生率高，颅底骨质破坏是引起骨转移发生的不良预后因素。

Abstract:
Objective To investigate the relationship between the skull base invasion and bone metastases in locally advanced nasopharyngeal carcinoma(NPC) patients.
Methods From January 1st, 2008 to March 31st, 2010, 518 patients with locally advanced NPC(Ⅲ stage, ⅣA stage, ⅣB stage, UICC2002 edition) were involved in this trial. All patients without prior treatment were divided into two groups according to skull base invasion or not: 243 cases without the skull base invasion (Group A), and 275 cases with the skull base invasion (Group B). We compared the incidence rate and the time of bone metastases between two groups.
Results The bone metastasis rate was 11.8%(61/518) in all involved patients, including 16(6.6%) cases in Group A and 45(16.4%) cases in Group B (P < 0.05). In 61 cases of bone metastases, single bone metastasis rate of Group B was higher than that of Group A (73.3% vs. 43.8%, P < 0.05); the median time of first bone metastasis in Group A and B were 14.0 and 19.1 months respectively, without significant difference (P > 0.05). Univariate and multivariate analysis showed that the skull base invasion was a poor prognostic factor for the bone metastasis in locally advanced NPC patients.
Conclusion The bone metastasis and single bone metastasis rate are high in the locally advanced NPC patients with skull base invasion. The skull base invasion is a poor prognostic factor for the bone metastasis.

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