孟祥超　　柏青　　阮亚超

[摘要] 目的 探討磁共振成像（MRI）检查鼻咽癌颈部淋巴结包膜侵犯患者的临床特征及与放疗后的预后关系。 方法 选取2015年10月至2017年1月在浙江省海宁市人民医院及浙江大学医学院附属第一医院治疗的鼻咽癌患者63例，采用MRI检查患者颈部淋巴结包膜侵犯情况，比较有包膜侵犯（n=28）和无包膜侵犯（n=35）患者临床资料及预后。 结果 经MRI检查发现，颈部有淋巴结包膜侵犯者28例（有包膜侵犯），颈部无淋巴结包膜侵犯者35例（无包膜侵犯）;有包膜侵犯者TNM分期Ⅲ～Ⅳ期比例为92.86%，明显高于无包膜侵犯者的71.43%（P<0.05）;有包膜侵犯患者无进展生存时间和总生存时间分别为36.00个月和45.00个月，明显短于无包膜侵犯患者的49.00个月、57.00个月（P<0.05）。 结论 在鼻咽癌患者中颈部有淋巴结包膜侵犯患者其TNM分期较高，且预后较差。

[关键词] 磁共振成像;鼻咽癌;淋巴结包膜侵犯;放疗;预后

[中图分类号] R739.63;R730.55          [文献标识码] B          [文章编号] 1673-9701（2021）14-0119-04

Clinical features of patients with neck lymph node capsule invasion of nasopharyngeal carcinoma examined by MRI and their relationships with prognosis of patients after radiotherapy

MENG Xiangchao1   BAI Qing2   RUAN Yachao3

1.Department of Radiology， Haining People′s Hospital in Zhejiang Province， Haining  314400， China; 2.Department of Oncology， Haining People′s Hospital in Zhejiang Province， Haining   314400， China; 3.Department of Radiology， the First Affiliated Hospital， Zhejiang University School of Medicine， Hangzhou   310000， China

[Abstract] Objective To investigate the clinical features of patients with neck lymph node capsule invasion of nasopharyngeal carcinoma examined by magnetic resonance imaging（MRI） and their relationships with prognosis of patients after radiotherapy. Methods A total of 63 patients with nasopharyngeal carcinoma admitted to Haining People′s Hospital in Zhejiang Province and the First Affiliated Hospital， Zhejiang University School of Medicine from October 2015 to January 2017 were selected. MRI was used to examine the capsule invasion of neck lymph nodes， and the clinical data and prognosis of patients with capsule invasion （n=28） and patients without capsule invasion（n=35） were compared. Results It was shown by MRI examination that there were 28 cases with neck lymph node capsule invasion（with capsule invasion） and 35 cases without neck lymph node capsule invasion（without capsule invasion）. The proportion of TNM stage Ⅲ-Ⅳ in patients with capsule invasion was 92.86%， which was significantly higher than that of 71.43% in patients without capsule invasion（P<0.05）. The progression-free survival time and total survival time of patients with capsule invasion were 36.00 months and 45.00 months respectively， which were significantly shorter than those of 49.00 months and 57.00 months without capsule invasion（P<0.05）. Conclusion Among patients with nasopharyngeal carcinoma， those with neck lymph node capsule invasion have higher TNM stages and poorer prognoses.

[Key words] Magnetic resonance imaging; Nasopharyngeal carcinoma; Lymph node capsule invasion; Radiotherapy; Prognosis

鼻咽癌是广东和广西最常见的恶性肿瘤之一，放射疗法被认为是优选疗法。随着调强放疗的使用，肿瘤的局部转移控制率大大提高[1]。远处转移是当前鼻咽癌化疗失败的主要原因，N分期是远距离转移的重要因素。鼻咽癌患者初诊时超过85%发生局部淋巴结转移，对临床分期、治疗计划和预后带来影响[2]。磁共振成像（MRI）具有较高的软组织分辨率，与B超、CT和PET-CT相比，可以提高区域淋巴结转移的诊断准确性，已成为鼻咽癌分期的首选[3]。最近研究发现，经组织病理学证实的头颈部鳞状细胞癌中淋巴结包膜浸润是肿瘤转移的不良预后指标[4]。目前，国内外对鼻咽癌淋巴结包膜患者生存的研究很少。本研究选取2015年10月至2017年1月在浙江省海宁市人民医院及浙江大学医学院附属第一医院治疗的鼻咽癌患者63例，旨在探讨MRI检查鼻咽癌颈部淋巴结包膜侵犯患者的临床特征及与放疗后的预后关系，现报道如下。……