目的:探讨咽旁侵犯对鼻咽癌预后的影响,并对多种咽旁侵犯程度的划分方法进行比较,以寻求能较好反映预后的划分。方法:2000-01-2000-07经病理确诊的初治M0期鼻咽癌患者176例纳入研究。根据4种咽旁划分方法(闵氏、Sham氏、肖氏和Heng氏建议的划分)对咽旁间隙的侵犯程度划分,前瞻性研究其对鼻咽癌预后的影响。结果:鼻咽癌咽旁侵犯的发生率为81.8%(144/176)。有咽旁侵犯和无咽旁侵犯的5年总生存率分别是68.1%和90.2%(P=0.010),5年无瘤生存率分别是66.1%和87.2%(P=0.013),5年无远处转移生存率分别是76.7%和93.6%(P=0.032),5年无局部复发生存率分别是84.9%和93.1%,P=0.220。Cox模型多因素分析显示,咽旁是否侵犯并不是独立预后因素,然而根据程度分级后的咽旁侵犯是影响预后的独立因素。4种咽旁划分同时纳入Cox多因素分析显示,闵氏划分的咽旁侵犯是影响总生存的独立预后因素(HR:2.231;P=0.001),Sham氏划分的咽旁侵犯是影响无瘤生存(HR:1.487;P=0.010)和远处转移(HR:1.246;P=0.009)的独立预后因素。结论:严重的咽旁侵犯是影响鼻咽癌总生存、无瘤生存和远处转移的独立预后因素,闵氏和Sham氏划分的咽旁侵犯对预后的影响最明显。 Objective: To explore the influence of parapharyngeal invasion on the prognosis of nasopharyngeal carcinoma, and to compare the methods of dividing many parapharyngeal lesions so as to seek the classification that can better reflect the prognosis. METHODS: A total of 176 patients with newly diagnosed NPC nasopharyngeal carcinoma diagnosed by pathology were enrolled in this study from January 2000 to July 2000. The extent of invasion of the parapharyngeal space was divided according to the four parapharyngeal division methods (Min’s, Sham’s, Shaw, and Heng’s recommendations) and prospectively studied the effect on the prognosis of NPC. Results: The incidence of NPC was 81.8% (144/176). The 5-year overall survival rates with parapharyngeal and non-parapharyngeal invasion were 68.1% and 90.2%, respectively (P = 0.010). The 5-year disease-free survival rates were 66.1% and 87.2% (P = 0.013) The distant metastasis survival rates were 76.7% and 93.6%, respectively (P = 0.032). The 5-year local recurrence-free survival rates were 84.9% and 93.1%, respectively, P = 0.220. Cox model multivariate analysis showed that the invasion of the parapharyngeal is not an independent prognostic factor, but according to the degree of classification of parapharyngeal invasion is an independent prognostic factor. Four parapharyngeal subdivisions combined with Cox multivariate analysis showed that parapharyngeal invasion by Min’s disease was an independent prognostic factor affecting overall survival (HR: 2.231; P = 0.001). Parapharyngeal invasion by Sham’s classification affected tumor-free survival (HR: 1.487; P = 0.010) and distant metastasis (HR: 1.246; P = 0.009). CONCLUSIONS: Severe parapharyngeal invasion is an independent prognostic factor affecting the overall survival, tumor-free survival and distant metastasis of nasopharyngeal carcinoma. The parathyroid invasion by Min and Sham’s classification has the most obvious prognosis.